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Field F, Olsson J, Hurley A. Alcohol Dependence and Rib Fracture Outcomes: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e42639. [PMID: 37644941 PMCID: PMC10461216 DOI: 10.7759/cureus.42639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Chronic alcohol use has been associated with impaired pulmonary function, increased risk of pneumonia and poor outcomes after trauma. With a high incidence of rib fractures in this population, the clinical and physiological factors associated with alcohol dependence may influence how these patients recover from thoracic injuries. Therefore, the aim of the systematic review was to examine the effect of alcohol dependence on rib fracture outcomes. The Embase, PubMed and Web of Science databases were searched for studies examining adult patients with rib fractures, with and without a history of alcohol dependency. The outcomes of interest were mortality, pulmonary complications, intensive care length of stay, ventilator days and hospital length of stay. A meta-analysis was performed to combine the data and compare results. Three studies met the criteria for inclusion in the review and all studies were observational in design. Alcohol dependency was associated with increased mortality (OR 1.44 (95% CI: 1.33-1.56)), pneumonia (OR 2.14 (2.02-2.27)) and ARDS (OR 1.71(1.48-1.98)) as well as longer stays in hospital and intensive care (p<0.05). No difference was found in ventilator days between the two groups. Early intensive care review should be considered to reduce complications in this population alongside prompt management of withdrawal symptoms. However, limited primary research exists on this topic and the quality of current evidence is low. Additional primary research is needed to further understand this correlation and draw meaningful conclusions.
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Affiliation(s)
- Fiona Field
- Trauma Sciences, Queen Mary University of London, London, GBR
| | - Jenny Olsson
- Anaesthetics, King's College Hospital NHS Foundation Trust, London, GBR
| | - Anna Hurley
- Plastic Surgery, Hull University Teaching Hospitals, Hull, GBR
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Bachoumas K, Levrat A, Le Thuaut A, Rouleau S, Groyer S, Dupont H, Rooze P, Eisenmann N, Trampont T, Bohé J, Rieu B, Chakarian JC, Godard A, Frederici L, Gélinotte S, Joret A, Roques P, Painvin B, Leroy C, Benedit M, Dopeux L, Soum E, Botoc V, Fartoukh M, Hausermann MH, Kamel T, Morin J, De Varax R, Plantefève G, Herbland A, Jabaudon M, Duburcq T, Simon C, Chabanne R, Schneider F, Ganster F, Bruel C, Laggoune AS, Bregeaud D, Souweine B, Reignier J, Lascarrou JB. Epidural analgesia in ICU chest trauma patients with fractured ribs: retrospective study of pain control and intubation requirements. Ann Intensive Care 2020; 10:116. [PMID: 32852675 PMCID: PMC7450151 DOI: 10.1186/s13613-020-00733-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
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.
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Affiliation(s)
| | - Albrice Levrat
- Intensive Care Unit, Regional Hospital Center, Annecy, France
| | - Aurélie Le Thuaut
- Plateforme de la méthodologie et de la Biostatistique, Direction de la Recherche Clinique, CHU de Nantes, 44093, Nantes Cedex, France
| | | | - Samuel Groyer
- Intensive Care Unit, Hospital Center, Montauban, France
| | - Hervé Dupont
- Surgical Intensive Care Unit, University Hospital, Amiens, France
| | - Paul Rooze
- Surgical Intensive Care Unit, University Hospital, Nantes, France
| | | | | | | | - Benjamin Rieu
- Surgical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | | | - Aurélie Godard
- Intensive Care Unit, Regional Hospital Center, Saint-Brieuc, France
| | - Laura Frederici
- Intensive Care Unit, Regional Hospital Center, Sud Francilien, Corbeil-Essone, France
| | | | - Aurélie Joret
- Surgical Intensive Care Unit, University Hospital, Caen, France
| | - Pascale Roques
- Intensive Care Unit, Regional Hospital Center, Cherbourg, France
| | - Benoit Painvin
- Intensive Care Unit, Regional Hospital Center, Lorient, France
| | - Christophe Leroy
- Intensive Care Unit, Regional Hospital Center, Puy en Velay, France
| | - Marcel Benedit
- Intensive Care Unit, Regional Hospital Center, Moulins, France
| | - Loic Dopeux
- Intensive Care Unit, Regional Hospital Center, Vichy, France
| | - Edouard Soum
- Intensive Care Unit, Regional Hospital Center, Périgueux, France
| | - Vlad Botoc
- Intensive Care Unit, Regional Hospital Center, Saint-Malo, France
| | - Muriel Fartoukh
- Intensive Care Unit, University Hospital, Tenon, Paris, France
| | | | - Toufik Kamel
- Intensive Care Unit, Regional Hospital Center, Orléans, France
| | - Jean Morin
- Respiratory Care Unit, University Hospital, Nantes, France
| | - Roland De Varax
- Intensive Care Unit, Regional Hospital Center, Macon, France
| | | | | | - Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand and GReD, CNRS, UMR 6293, INSERM U1103, Universite Clermont Auvergne, Clermont-Ferrand, France
| | | | - Christelle Simon
- Intensive Care Unit, Regional Hospital Center, Versailles, France
| | - Russell Chabanne
- Neurological Intensive Care Unit, University Hospital, Clermont-Ferrand, France
| | - Francis Schneider
- Médecine Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Cedric Bruel
- Intensive Care Unit, Saint-Joseph Hospital Center, Paris, France
| | | | | | - Bertrand Souweine
- Medical Intensive Care Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Jean Reignier
- Médecine Intensive Réanimation, University Hospital, Nantes, France
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