Traumatically Injured Patients with Positive Toxicology Screening and Ability to Wean from Mechanical Ventilation

Abstract

Background: The adverse effects of mechanical ventilation (MV) are a major health concern associated with poor outcomes and economic burden. Some populations, such as those requiring more than one attempt at the gradual removal of MV (weaning), are at risk for longer duration of MV and associated complications. Traumatically injured patients have a higher prevalence of positive illicit drug toxicology then the general population. The traumatically injured, positive for illicit drugs who requires MV, may experience the sequelae of withdrawal syndrome and violate the thresholds that allow weaning, leading to longer durations MV. Methods: A retrospective descriptive analysis of a convenience sample of 52 adult trauma patients from SJHMC admitted between January 1 to December 31, 2014 who presented positive for illicit drugs and required mechanical ventilation. This sample was analyzed to: 1) describe the characteristics of this specific sample, 2) determine the prevalence of a difficult-to-wean subsample, 3) describe the characteristics of this sample during weaning attempts, and 4) determine if the existing weaning protocol necessitates amending. Results: Samples ability to wean; 78.8% (n=41) simple weaning; 15.38% (n=8) difficult weaning; and 5.77% (n=3) prolonged. Zero cases of adverse effects of MV or withdrawal syndrome detected. There was no correlation between stimulant and/or depressant and ability to wean (p=0.662). There was no relationship between injury severity score (ISS) and weaning group (p=0.762). Characteristics identified included; male to female ratio 4:1 and majority with ISS score>24. Variables within weaning protocol were missing 25-84% of data. Conclusion: The ability to wean MV in this sample is similar to what is reported in the general population, suggesting that they are not at risk for difficult weaning or prolonged MV. This sample’s majority was comprised of more traumatically complex, young males than found in the general trauma population. Investigators were unable to analyze or amend the current protocol because of the large amounts of missing data indicating possible gaps in adherence and/or documentation. To our knowledge, this is the first project that describes ability to wean in the traumatically injured positive for illicit drug.