Background Emergency tracheal intubation during
major trauma resuscitation may be associated with
unrecognised endobronchial intubation. The risk factors
and outcomes associated with this issue have not
previously been fully defined.
Methods We retrospectively analysed adult patients
admitted directly from the scene to the ED of a single
level 1 trauma centre, who received either prehospital
or ED tracheal intubation prior to initial whole-body
CT
from January 2008 to December 2019. Our objectives
were to describe tube-to-
carina
distances (TCDs) via CT
and to assess the risk factors and outcomes (mortality,
length of intensive care unit stay and mechanical
ventilation) of patients with endobronchial intubation
(TCD <0 cm) using a multivariable model.
Results We included 616 patients and discovered 26
(4.2%) cases of endobronchial intubation identified
on CT. Factors associated with an increased risk of
endobronchial intubations were short body height
(OR per 1 cm increase 0.89; 95% CI 0.84 to 0.94;
p≤0.001), a high body mass index (OR 1.14; 95% CI
1.04 to 1.25; p=0.005) and ED intubation (OR 3.62;
95% CI 1.39 to 8.90; p=0.006). Eight of 26 cases
underwent tube thoracostomy, four of whom had no
evidence of underlying chest injury on CT. There was no
statistically significant difference in mortality or length
of stay although the absolute number of endobronchial
intubations was small.
Conclusions Short body height and high body mass
index were associated with endobronchial intubation.
Before considering tube thoracostomy in intubated
major trauma patients suspected of pneumothorax, the
possibility of unrecognised endobronchial intubation
should be considered.
| Identifer | oai:union.ndltd.org:DRESDEN/oai:qucosa:de:qucosa:86433 |
| Date | 11 July 2023 |
| Creators | Heyne, Guido, Ewens, Sebastian, Kirsten, Holger, Fakler, Johannes Karl Maria, Özkurtul, Orkun, Hempel, Gunther, Krämer, Sebastian, Struck, Manuel Florian |
| Publisher | BMJ Publishing Group |
| Source Sets | Hochschulschriftenserver (HSSS) der SLUB Dresden |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, doc-type:article, info:eu-repo/semantics/article, doc-type:Text |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 1472-0205 |
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