Low incidence of multiple organ failure after major trauma

SummaryBackgroundIn major trauma patients, multiple organ failure (MOF) is considered a leading cause of death. Acute lung injury is deemed a “pacemaker” of MOF. The purpose of this study was to determine if incidence of organ failure and mortality in multiple trauma patients can be reduced by implementation of lung-protective strategies.MethodsAll critically ill multiple trauma patients admitted to the ICU of a major trauma center in Berlin, Germany from January 1999 to December 2002 were analyzed retrospectively. Patients were ventilated pressure controlled with low tidal volumes and adequate PEEP.Resultsn = 287 patients were included. The most frequent injuries were traumatic brain injury (TBI—68%), chest trauma (68%), and lung contusions (55%). Injury severity score (ISS) was 32 ± 19 (mean ± standard deviation), polytraumaschluessel (PTS) 34 ± 19, and APACHE II 14 ± 7. During their ICU-stay 16 patients died, 9 (56%) from TBI. Single-organ-failure occurred in n = 69 patients (24%, mortality 5%), two-organ-failure in n = 22 (8%, mortality 14%), and MOF in n = 9 (3%, mortality 13%); one patient died from MOF 14 days after trauma. The number of days on mechanical ventilation increased depending on the number of organs failed (R = 0.618, p < 0.001). Seven patients (2%) fulfilled ARDS criteria for longer than 24 h despite optimized ventilatory settings, one died of irreversible shock. Patients with MOF had a significantly increased ICU-LOS (35 ± 15 days) compared to patients without organ failure (11 ± 11 days; p < 0.001).ConclusionThe low incidence of MOF in our series of trauma patients suggests that MOF may be prevented in some patients by implementation of lung-protective strategies. The improved outcome was associated with an increased ICU-LOS.