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1788: SHORTER SEDATION TIME INCREASES PROPORTION OF COMA-/DELIRIUM-FREE DAYS AFTER OPEN ABDOMEN FOR TRAUMA

Learning Objectives: Traumatic brain injury (TBI) is the most common cause of death in trauma patients. In conjunction to neurologic sequelae that can develop, trauma patients with severe TBI have a predilection towards development of pulmonary complications independent of neck injury. In particular, these patients commonly develop lobar collapse. At our urban level 1 trauma center, we sought to evaluate a standardized protocol aimed at lobar collapse prevention in this particular population. Methods: A retrospective data analysis was performed comparing 3 groups: patients without TBI, patients with TBI without use of pulmonary hygiene and patients with TBI with use of pulmonary hygiene. On admission, all patients enrolled were evaluated and found to not have neck injury. Protocol included suctioning and percussion aimed at clearing secretions. Data obtained included age, ventilator days, ICU length of stay (ICU-LOS in days), hospital length of stay (HLOS in days), mortality, pneumonia incidence, incidence of lobar collapse, Injury Severity Score (ISS), and Anatomic Injury Scale (AIS). Data was analyzed using one-way analysis of variance (ANOVA). Results: 310 patients trauma patients were enrolled divided into 3 groups: patients without TBI (104 patients), patients with TBI without pulmonary hygiene (101 patients) and patients with TBI with pulmonary hygiene (105 patients). Mean age was 51.4 years with mean ISS of 22.5, and mean AIS of 3.1 among patients with TBI. Pulmonary hygiene protocol demonstrated significant reduction in incidence of lobar collapse similar to patients without TBI (11% vs. 27% vs. 10%, p = 0.0009). No significant difference was noted in ventilator days, ICU-LOS, HLOS, mortality or incidence of pneumonia. Conclusions: TBI patients have a predilection towards development of lobar collapse, which can be significantly reduced by use of pulmonary hygiene.