Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements

• Main Authors: Konstantinos Bachoumas, Albrice Levrat, Aurélie Le Thuaut, Stéphane Rouleau, Samuel Groyer, Hervé Dupont, Paul Rooze, Nathanael Eisenmann, Timothée Trampont, Julien Bohé, Benjamin Rieu, Jean-Charles Chakarian, Aurélie Godard, Laura Frederici, Stephanie Gélinotte, Aurélie Joret, Pascale Roques, Benoit Painvin, Christophe Leroy, Marcel Benedit, Loic Dopeux, Edouard Soum, Vlad Botoc, Muriel Fartoukh, Marie-Hélène Hausermann, Toufik Kamel, Jean Morin, Roland De Varax, Gaetan Plantefève, Alexandre Herbland, Matthieu Jabaudon, Thibault Duburcq, Christelle Simon, Russell Chabanne, Francis Schneider, Frederique Ganster, Cedric Bruel, Ahmed-Saïd Laggoune, Delphine Bregeaud, Bertrand Souweine, Jean Reignier, Jean-Baptiste Lascarrou
• Format: Article
• Language: English
• Published: SpringerOpen 2020-08-01
• Series: Annals of Intensive Care
• Subjects: Epidural analgesia; Chest trauma
• Online Access: http://link.springer.com/article/10.1186/s13613-020-00733-0

Abstract Background Nonintubated chest trauma patients with fractured ribs admitted to the intensive care unit (ICU) are at risk for complications and may require invasive ventilation at some point. Effective pain control is essential. We assessed whether epidural analgesia (EA) in patients with fractured ribs who were not intubated at ICU admission decreased the need for invasive mechanical ventilation (IMV). We also looked for risk factors for IMV. Study design and methods This retrospective, observational, multicenter study conducted in 40 ICUs in France included consecutive patients with three or more fractured ribs who were not intubated at admission between July 2013 and July 2015. Results Of the 974 study patients, 788 were included in the analysis of intubation predictors. EA was used in 130 (16.5%) patients, and 65 (8.2%) patients required IMV. Factors independently associated with IMV were chronic respiratory disease (P = 0.008), worse SAPS II (P < 0.0001), flail chest (P = 0.02), worse Injury Severity Score (P = 0.0003), higher respiratory rate at admission (P = 0.02), alcohol withdrawal syndrome (P < 0.001), and noninvasive ventilation (P = 0.04). EA was not associated with decreases in IMV requirements, median numerical rating scale pain score, or intravenous morphine requirements from day 1 to day 7. Conclusions EA was not associated with a lower risk of IMV in chest trauma patients with at least 3 fractured ribs, moderate pain, and no intubation on admission. Further studies are needed to clarify the optimal pain control strategy in chest trauma patients admitted to the ICU, notably those with severe pain or high opioid requirements.