|
Baseline characteristics
|
|
Age, years, mean ± SD
|
55 ± 17a
|
57 ± 16b
|
0.15
|
|
History of chronic respiratory disease, n (%)
|
83/653 (12.7%)
|
14/130 (10.8%)
|
0.54
|
|
History of alcoholism, n (%)
|
105/640 (16.4%)
|
26/123 (21.1%)
|
0.20
|
|
History of smoking, n (%)
|
227/633 (35.9%)
|
44/123 (35.8%)
|
0.98
|
|
Obesity (BMI ≥ 30), n (%)
|
83/648 (12.8%)
|
25/126 (19.8%)
|
0.04
|
|
Number of fractured ribs ≥ 6, n (%)
|
312/656 (47.6%)
|
87/129 (67.4%)
|
< 0.0001
|
|
Flail chest, n (%)
|
143/648 (22.1%)
|
57/129 (44.2%)
|
< 0.0001
|
|
Thoracic AIS (mean ± SD)
|
3.46 ± 0.61
|
3.75 ± 0.53
|
< 0.0001
|
|
Injury Severity Score, mean ± SD
|
17.5 ± 7.0
|
20.2 ± 7.0
|
0.0001
|
|
SAPS II, mean ± SD
|
21 ± 10c
|
21 ± 9d
|
0.46
|
|
Clinical variables at ICU admission
|
|
Oxygen saturation, %, mean ± SD
|
96 ± 5e
|
96 ± 3f
|
0.81
|
|
Respiratory rate, breaths/min, mean ± SD
|
20 ± 5 g
|
20 ± 5 h
|
0.87
|
|
Oxygen flow > 6 L/min, n (%)
|
117/649 (18.0%)
|
37/127 (29.1%)
|
0.004
|
|
History of alcoholism
|
|
No
|
535i
|
97j
|
0.41
|
|
Yes, without symptoms of withdrawal
|
80
|
19
| |
|
Yes, with symptoms of withdrawal
|
25
|
7
| |
|
Outcomes
|
|
Median NRS pain score on day 1 > 4, n (%)
|
243/637 (38.1%)
|
60/125 (48.0%)
|
0.04
|
|
Maximum NRS pain score from day 1 to day 4, median [IQR]
|
6 [5.0–8.0]
|
7 [5.0–8.0]
|
0.03
|
|
Median numerical rating scale pain score, median [IQR]
|
|
Day 1
|
3.0 [1.0–5.0]k
|
3.5 [1.0–5.0]l
|
0.23
|
|
Day 2
|
2.5 [1.0–4.0]k
|
2.5 [0.5–4.0]l
|
0.37
|
|
Day 3
|
2.0 [0.0–4.0]k
|
2.0 [0.0–3.0]l
|
0.49
|
|
Day 4
|
2.0 [0.0–3.5]k
|
1.0 [0.0–3.0]l
|
0.01
|
|
Day 5
|
2.0 [0.0–3.5]k
|
1.0 [0.0–3.0]l
|
0.09
|
|
Day 6
|
2.0 [0.0–3.0]k
|
2.0 [0.0–3.0]l
|
0.36
|
|
Day 7
|
1.5 [0.0–3.0]k
|
2.0 [0.0–3.5]l
|
0.64
|
|
Intravenous morphine
|
|
Day 1, n (%)
|
395/657 (60.1%)
|
76/130 (58.5%)
|
0.72
|
|
Dose during the first 24 h in the ICU, mg, median [IQR]
|
5 [0–16]m
|
5.0 [0.0–14]n
|
0.78
|
|
Day 7, n (%)
|
62/657 (9.4%)
|
27/130 (20.8%)
|
0.0002
|
|
Other analgesics during the first 7 ICU days, n (%)
|
|
NSAIDs
|
186/629 (29.6%)
|
42/129 (32.6%)
|
0.50
|
|
Ketamine
|
63/625 (10.1%)
|
18/127 (14.2%)
|
0.17
|
|
Nefopam
|
478/639 (74.8%)
|
96/128 (75.0%)
|
0.96
|
|
Paracetamol
|
625/654 (95.6%)
|
124/129 (96.1%)
|
0.78
|
|
Tramadol
|
361/633 (57.0%)
|
69/129 (53.5%)
|
0.46
|
|
Intercostal anesthesia
|
18/658 (2.1%)
| | |
|
Days with intercostal anesthesia, median [IQR]
|
4 [3–5.5]
| | |
|
Epidural analgesia
|
|
Patients with EA, n (%)
| |
130/788 (16.5%)
| |
|
Time from hospital admission to EA, days, median [IQR]
| |
1 [0–2]
| |
|
Time from ICU admission to EA, days, median [IQR]
| |
1 [0–2]
| |
|
EA duration, days, mean ± SD
| |
4.1 ± 2.2o
| |
|
Local anesthetics, n (%)
|
|
Ropivacaine
| |
118/124 (95.2%)
| |
|
Bupivacaine
| |
0/124 (0%)
| |
|
Levobupivacaine
| |
6/124 (4.8%)
| |
|
Local opioids, n (%)
|
|
Sufentanil
| |
96/125 (76.8%)
| |
|
Morphine
| |
7/125 (5.6%)
| |
|
None
| |
22/125 (17.6%)
| |
|
Complications, n (%)
|
|
Epidural hematoma
| |
0
| |
|
Epidural abscess
| |
0
| |
|
Severe hypotension
| |
1
| |
|
No pain relief from EA, n (%)
| |
5/111 (4.5%)
| |
|
Mechanical ventilation
|
|
IMV, n (%)
|
53/658 (8.0%)
|
12/130 (9.2%)
|
0.65
|
|
Time from ICU admission to IMV, days, median [IQR]
|
2 [1–4]p
|
2.5 [1.5–5]q
|
0.52
|
|
IMV duration, days, median [IQR]
|
9.5 [5–16]p
|
10 [4.5–13]q
|
0.97
|
|
Reason of IMV initiation (more than one possible for each patient)
|
|
Acute respiratory failure
|
51
|
10
|
0.15
|
|
Acute neurologic failure
|
6
|
3
|
0.35
|
|
Acute circulatory failure
|
3
|
1
|
0.57
|
|
Noninvasive ventilation, n (%)
|
146/647 (22.6%)
|
58/129 (45.0%)
|
< 0.0001
|
|
ICU stay length, days, median [IQR]
|
5 [2–8]r
|
8 [6–12]
|
< 0.0001
|
|
Hospital stay length, days, median [IQR]
|
10 [6–17]s
|
13 [9–18]t
|
0.0002
|
|
ICU mortality, n (%)
|
13/653 (2.0%)
|
5/129 (3.9%)
|
0.20
|
|
Hospital mortality, n (%)
|
15/650 (2.3%)
|
5/127(3.9%)
|
0.35
|
