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. 1985 Jun;201(6):752–757. doi: 10.1097/00000658-198506000-00012

Patterns of infection and mortality in thoracic trauma.

W E Walker, D P Kapelanski, A P Weiland, J D Stewart, J H Duke Jr
PMCID: PMC1250811  PMID: 4004387

Abstract

Tissue infection and systemic sepsis are common causes of morbidity and late mortality after major thoracic trauma. To seek causative mechanisms, prognostic indicators, and areas of possible improvement in therapy, we reviewed 310 consecutive adults admitted with major thoracic trauma. Of these, 56 (18%) died of massive injuries in the first 5 days; the remaining 254 were considered at risk for infectious complications. There were 21 late deaths in this group, and 15 (71%) were caused by systemic sepsis. Eighty-four patients (33%) developed thoracic infections, and 15 (6%) had significant nonthoracic infections. Markers of increased risk of infection included blunt injury, shock and unconsciousness on arrival, and splenectomy. Pulmonary infection was increased significantly following prolonged endotracheal intubation, but was virtually absent following tracheostomy. The risk of infection was increased significantly if prophylactic antibiotics were not used, but no definite correlation could be made to advanced age, pre-existent disease, nor post-traumatic malnutrition. Attention to some of these factors may decrease the risk of infection in thoracic trauma.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barrett J., Sheaff C., Abuabara S., Jonasson O. Splenic preservation in adults after blunt and penetrating trauma. Am J Surg. 1983 Mar;145(3):313–317. doi: 10.1016/0002-9610(83)90189-7. [DOI] [PubMed] [Google Scholar]
  2. Dickerman J. D. Traumatic asplenia in adults: a defined hazard? Arch Surg. 1981 Mar;116(3):361–363. doi: 10.1001/archsurg.1981.01380150079022. [DOI] [PubMed] [Google Scholar]
  3. Dunham C. M., LaMonica C. Prolonged tracheal intubation in the trauma patient. J Trauma. 1984 Feb;24(2):120–124. doi: 10.1097/00005373-198402000-00005. [DOI] [PubMed] [Google Scholar]
  4. Ein S. H., Shandling B., Simpson J. S., Stephens C. A., Bandi S. K., Biggar W. D., Freedman M. H. The morbidity and mortality of splenectomy in childhood. Ann Surg. 1977 Mar;185(3):307–310. doi: 10.1097/00000658-197703000-00010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. El-Naggar M., Sadagopan S., Levine H., Kantor H., Collins V. J. Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure: a prospective study. Anesth Analg. 1976 Mar-Apr;55(2):195–201. doi: 10.1213/00000539-197603000-00015. [DOI] [PubMed] [Google Scholar]
  6. Friman L., Hedenstierna G., Schildt B. Stenosis following tracheostomy. A quantitative study of long term results. Anaesthesia. 1976 May;31(4):479–493. doi: 10.1111/j.1365-2044.1976.tb12353.x. [DOI] [PubMed] [Google Scholar]
  7. Greco R. S., Alvarez F. E. Protection against pneumococcal bacteremia by partial splenectomy. Surg Gynecol Obstet. 1981 Jan;152(1):67–69. [PubMed] [Google Scholar]
  8. Pachter H. L., Hofstetter S. R., Spencer F. C. Evolving concepts in splenic surgery: splenorrhaphy versus splenectomy and postsplenectomy drainage: experience in 105 patients. Ann Surg. 1981 Sep;194(3):262–269. doi: 10.1097/00000658-198109000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Reul G. J., Jr, Mattox K. L., Beall A. C., Jr, Jordan G. L., Jr Recent advances in the operative management of massive chest trauma. Ann Thorac Surg. 1973 Jul;16(1):52–66. doi: 10.1016/s0003-4975(10)65812-2. [DOI] [PubMed] [Google Scholar]
  10. Richardson J. D., DeCamp M. M., Garrison R. N., Fry D. E. Pulmonary infection complicating intra-abdominal sepsis: clinical and experimental observations. Ann Surg. 1982 Jun;195(6):732–738. doi: 10.1097/00000658-198206000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Shackford S. R., Virgilio R. W., Peters R. M. Selective use of ventilator therapy in flail chest injury. J Thorac Cardiovasc Surg. 1981 Feb;81(2):194–201. [PubMed] [Google Scholar]
  12. Stauffer J. L., Olson D. E., Petty T. L. Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. Am J Med. 1981 Jan;70(1):65–76. doi: 10.1016/0002-9343(81)90413-7. [DOI] [PubMed] [Google Scholar]
  13. Zwillich C. W., Pierson D. J., Creagh C. E., Sutton F. D., Schatz E., Petty T. L. Complications of assisted ventilation. A prospective study of 354 consecutive episodes. Am J Med. 1974 Aug;57(2):161–170. doi: 10.1016/0002-9343(74)90440-9. [DOI] [PubMed] [Google Scholar]

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