28 de fevereiro de 2013

Artigo recomendado: Case Scenario: Pain-associated Respiratory Failure in Chest Trauma

Young Ahn, Klaus Görlinger, Hasan B. Alam, Matthias Eikermann

Anesthesiology 2013; 118:701-8, Ahn et al.

The leading cause of death in young people is trauma. Chest trauma has high associated mortality, thus diagnosis and treatment need to be addressed early on presentation. The incidence of rib fractures range from 10% to 26% in traumatic thoracic injury and the number of rib fractures independently predict patients’ pulmonary morbidity and mortality. Numerous cardiopulmonary to neurologic causes such as tamponade, hemo- pneumothorax, and cervical spine injury can be implicated. Severe respiratory distress can also result from breathing-dependent pain where parenteral opioids are often insufficient in addressing the pain and associated respiratory failure. Epidural analgesia is associated with reduction in mortality for all patients with multiple rib fractures but is underused, in part due to the potential risks of epidural hematomas.

Variables that alter the risk of bleeding including age and sex, comorbidities such as diabetes and liver cirrhosis, severity of trauma and degree of resuscitation, and anticoagulation or antiplatelet therapy must also be considered.

We describe a patient under clopidogrel therapy presenting to the intensive care unit (ICU) with severe respiratory distress that improved with epidural analgesia. We provide a discussion of the risks and benefits of neuraxial analgesia in patients presenting with rib-fracture pain-related respiratory failure.

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