Prolonged Respiratory Failure in Pediatric Combat Trauma Patients

First Author(s)

• 

  Andrew Moulton, MD

  Pediatric Resident
  n/a

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• SS

  Steve Schauer, DO, MSCR

  Capability Area Manager
  US Army Institute of Surgical Research, Texas, United States

  Disclosure information not submitted.
• MB

  Matthew Borgman, MD, FCCM

  Associate Professor
  Uniformed Services University
  San Antonio, Texas, United States

  Disclosure information not submitted.

Title: Prolonged respiratory failure in pediatric combat trauma patients



Introduction: It is well known that polytrauma can lead to lung injury and respiratory failure has been previously observed in combat trauma, but not reported in children, who account for over 11% of bed days at Military Treatment Facilities, requiring a significant amount of resources. We seek to identify risk factors associated with prolonged respiratory failure (PRF) which is important in resource planning and allocation in austere environments.


Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric subjects < 18 years old admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. PRF was defined as >/= 5 days, and deaths on day zero were excluded. Serious injuries were defined an abbreviated injury scale by body region of 3 or greater. Tachycardia and blood pressure were adjusted for age and treated as binary variables. Forward stepwise multivariable linear regression model was used to identify factors associated with prolonged ventilation.


Results: Of 3333 casualties included in the analysis, 323 (9.7%) had PRF. On unadjusted analysis, age, hypotension, tachycardia, lowest saturation value, max INR, max base deficit, min hematocrit, 24 hour volume/kg administration of RBC, FFP and crystalloids, as well as serious injury to head/neck, thorax, abdomen, skin were included in model (p< 0.1). In the final model, unit odds ratios (95%CI) associated with PRF were: head/neck 3.3 (2.3-4.7), thorax 2.5 (1.7-3.8), abdomen 1.7 (1.09-2.75), skin 3.56 (2.06-6.14), RBC 1.01 (1.01-1.02), FFP 1.01 (1.00-1.02), crystalloids 1.00 (1.00-1.01), base deficit 1.04 (1.01-1.09). Hypotension 0.78 (0.49-1.25) and saturation 0.99 (0.97-1.00) were not significant. Model goodness-of-fit r² was 0.23.


Conclusions: In this first analysis of factors association with PRF in pediatric combat trauma, in addition to serious injuries to head/neck, thorax, abdomen, and skin, we found that base deficit, transfusions of RBC and FFP, as well as administration of crystalloids were independently associated with PRF. This may help identify children at risk for PRF and help resource allocation and planning for remote medical facilities.