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Paediatric thoracic injury and traumatic brain damage: clinical importance and effects on ventilation

Linda Hollander

Purpose

This study compares patterns of mechanical breathing in patients with or without accompanying moderate-to-severe Traumatic Brain Injury (TBI) and describes the epidemiology and management of chest trauma

Methods

This retrospective analysis included all kids who were referred to our level-1 trauma center after experiencing chest trauma between February 2012 and December 2018.

Results

There were 75 patients in all, with a median age of 11 [6-13] years with thoracic injuries. The majority of patients (n = 71, 95%) also had extra-thoracic injuries, and 59 (79%) also had TBI. 31 patients (41%) were receiving mechanical ventilation, and a total of 52 patients (69%) were admitted to intensive care. There was no change in tidal volume or positive end-expiratory pressure between patients with moderate-to-severe TBI and those with minimal or mild TBI in patients who needed mechanical ventilation. An isolated case of acute respiratory distress syndrome occurred in a patient. Six patients (8%) died overall, and all six had moderate-to-severe TBI.

Conclusion

The majority of the patients in this small retrospective cohort who required mechanical breathing after chest trauma also had associated moderate-to-severe TBI. The use of mechanical ventilation to treat TBI does not appear to be linked to an increase in cases of acute respiratory distress syndrome.