Mechanical ventilation in trauma-the first 24 hours: A retrospective analysis

Introduction: Warfare injuries are a special subset of trauma, involving complex injury mechanisms and extensive tissue damage. Theses mechanisms may lead to significant deterioration in lung function even in the absence of any signs of external thoracic injury due to primary or secondary insult on the lungs. The mainstay in the management of these battlefield lung injuries is by initiating mechanical ventilation which either replaces or assists the functions of the respiratory system. Materials and Methods: A retrospective analysis was done from 1st January 2016 to 31st June 2016 of the data taken from the trauma register of our hospital. Data was analysed and the need for mechanical ventilation was correlated with factors like injury severity score (ISS), injury profile and pulmonary and extrapulmonary using confidence interval and Odds ratio. Paired differences were tested using Wilcoxon signed rank test. Results: Of the 528 warfare casualties received a total of 469 patients were enrolled and 94(20.04%) required mechanical ventilation in the immediate post-operative period and another 06 patients needed ventilation in the first 24 hours due to development of fat embolism syndrome. All patients had an ISS of greater than 27(48.9±12.6) as compared to non-ventilated patients (odds 1.1, 95% CI, 0.85-1.45, P=0.42). Conclusion: Acute lung injury is a major cause of increased morbidity in patients with warfare injuries. An aggressive and proactive approach of initiating mechanical ventilation can bring down complications and ICU stays. Injury severity scoring can be used for predicting ALI in warfare casualties. Lung protective ventilatory strategies can enhance patient recovery.