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Master Thesis

Utilisation de l'analgésie locorégionale chez le traumatisé thoracique sous ventilation mécanique : une étude préliminaire

Abstract : Background: the benefit-risk ratio of locoregional procedures during the weaning process has been poorly investigated in blunt chest trauma patients. The main objective of this study was to determine whether the use of locoregional analgesia in mechanically ventilated chest trauma patients was associated with an increased ventilator-free days and a better clinical outcome. Methods: over a 5-year period, every adult patient with multiple rib fractures who required mechanical ventilation during their ICU stay were retrospectively included. Non-inclusion criteria were patients with less than 3 ribs fractures, traumatic cardiac arrest, severe traumatic brain injury or traumatic spinal cord injury. Two groups of patients were compared according to the use or not of locoregional analgesia at the time of the first extubation (treatment group vs. control group). A propensity score analysis was performed to adjust for potential baseline differences between the treatment and control groups. Multivariable regression models were used to test the association between locoregional analgesia at the time of the first extubation and 28-day ventilator-free days, ICU or hospital ventilator-free days and extubation failure, adjusting for covariates associated with clinical outcome. Results: during the study period, 218 patients were included. In the propensity-matched population, the use of locoregional analgesia at the time of the first extubation was associated with 3.72 [2.33 – 5.11] more days alive without mechanical ventilation. There was a significant association between locoregional analgesia at the time of the first extubation and ICU or hospital ventilator-free days (adjusted effect = 1.34 [1.01 – 1.80] and adjusted effect = 1.49 [1.11 – 1.99] respectively). The use of locoregional analgesia at the time of extubation was not associated with a lower rate of extubation failure (adjusted OR = 0.33 [0.08 – 1.40]). The overall rate of complications was not higher when locoregional analgesia was performed under mechanical ventilation (37% vs. 37%, p = 0.835). Conclusion: in mechanically ventilated blunt chest trauma patients, the use of locoregional procedure during the weaning process was associated with lower durations under mechanical ventilation without increased risk of extubation failure.
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  • HAL Id : dumas-02498684, version 1

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Charlotte Robert. Utilisation de l'analgésie locorégionale chez le traumatisé thoracique sous ventilation mécanique : une étude préliminaire. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02498684⟩

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