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Atrial fibrillation in trauma patients requiring intensive care

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Abstract

Objectives

To evaluate the incidence and risk factors of atrial fibrillation (AF) in trauma patients.

Design and setting

Prospective observational study in a surgical intensive care unit (ICU).

Patients

All trauma patients admitted in the surgical ICU except those who had AF at admission.

Measurements and results

AF occurred in 16/293 patients (5.5%). AF patients were older, had a higher number of regions traumatized, and received more fluid therapy, transfusion products, and catecholamines. They more frequently experienced systemic inflammatory response syndrome, sepsis, shock, and acute renal failure and had higher scores of severity (Simplified Acute Physiology Score, SAPS II; Injury Severity Score). ICU length of stay and resources use were also increased. ICU and hospital mortality rates were twice higher in AF patients whereas standardized mortality ratio (observed/expected mortality by SAPS  II) was similar in the two groups. We found five independent risk factors of developing AF: catecholamine use (OR = 5.7, 95% CI 1.7–19.1), SAPS II of 30 or higher (OR = 11.6, 95% CI  1.3–103.0), three or more regions traumatized (OR = 6.2, 95% CI 1.8–21.4), age 40 years or higher (OR = 6.3, CI 1.4–28.7), and systemic inflammatory response syndrome (OR = 4.4, 95% CI 1.2–16.1).

Conclusions

In addition to age and catecholamine use, inflammation and severity of injury may be involved in the development of AF in trauma patients. Our results suggest that AF could rather be a marker of a higher severity of illness without major effect on mortality.

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References

  1. Artucio H, Pereira M (1990) Cardiac arrhythmias in critically ill patients: epidemiologic study. Crit Care Med 18:1383–1388

    Article  PubMed  CAS  Google Scholar 

  2. Bender JS (1996) Supraventricular tachyarrhythmias in the surgical intensive care unit: an under-recognized event. Am Surg 62:73–75

    PubMed  CAS  Google Scholar 

  3. Reinelt P, Delle Karth G, Geppert A, Heinz G (2001) Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU. Intensive Care Med 27:1466–1473

    Article  PubMed  CAS  Google Scholar 

  4. Knotzer H, Mayr A, Ulmer H, Lederer W, Schobersberger W, Mutz N, Hasibeder W (2000) Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study. Intensive Care Med 26:908–914

    Article  PubMed  CAS  Google Scholar 

  5. Brathwaite D, Weissman C (1998) The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest 114:462–468

    Article  PubMed  CAS  Google Scholar 

  6. Seguin P, Signouret T, Laviolle B, Branger B, Mallédant Y (2004) Incidence and risk factors of atrial fibrillation in a surgical intensive care unit. Crit Care Med 32:722–726

    Article  PubMed  Google Scholar 

  7. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT (2004) for the investigators of the Ischemia Research and Education Foundation and the Multicenter Study of Perioperative Ischemia Research Group. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 291:1720–1729

    Article  PubMed  CAS  Google Scholar 

  8. McLean RF, Devitt JH, McLellan BA, Dubbin J, Ehrlich LE, Dirkson D (1992) Significance of myocardial contusion following blunt chest trauma. J Trauma 33:240–243

    PubMed  CAS  Google Scholar 

  9. Cachecho R, Grindlinger GA, Lee VW (1992) The clinical significance of myocardial contusion. J Trauma 33:68–73

    PubMed  CAS  Google Scholar 

  10. Moore FA, Sauaia A, Moore EE, Haenel JB, Burch JM, Lezotte DC (1996) Postinjury multiple organ failure: a bimodal phenomenon. J Trauma 40:501–512

    PubMed  CAS  Google Scholar 

  11. Chung MK, Martin DO, Sprecher D, Wazni O, Kanderian A, Carnes CA, Bauer JA, Tchou PJ, Niebauer MJ, Natale A, Van Wagoner DR (2001) C-reactive protein elevation in patients with atrial arrhythmias: inflammatory mechanisms and persistence of atrial fibrillation. Circulation 104:2886–2891

    Article  PubMed  CAS  Google Scholar 

  12. Aviles RJ, Martin DO, Apperson-Hansen C, houghtaling PL, Rautaharju P, Kronmal RA, Tracy RP, Van Wagoner DR, Psaty BM, Lauer MS, Chung MK (2003) Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006–3010

    Article  PubMed  Google Scholar 

  13. Hollenberg SM, Dellinger RP (2000) Noncardiac surgery: postoperative arrhythmias. Crit Care Med 28:145–150

    Article  Google Scholar 

  14. Baker SP, O'Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  PubMed  CAS  Google Scholar 

  15. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  PubMed  Google Scholar 

  16. Girou E, Stephan F, Novara A, Safar M, Fagon JY (1998) Risk factors and outcome of nosocomial infections: result of a matched case-control study of ICU patients. Am J Respir Crit Care Med 157:1151–1158

    PubMed  CAS  Google Scholar 

  17. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RMH, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655

    Article  PubMed  CAS  Google Scholar 

  18. Califf RM, Bengtson JR (1994) Cardiogenic shock. N Engl J Med 330:1724–1730

    Article  PubMed  CAS  Google Scholar 

  19. Bellomo R, Kellum J, Ronco C (2001) Acute renal failure: time for consensus. Intensive Care Med 27:1685–1688

    Article  PubMed  CAS  Google Scholar 

  20. Hosmer DW, Lemeshow S, Saulnier F (1995) Confidence interval estimates of an index of quality performance based on logistic regression models. Stat Med 14:2161–2172

    Article  PubMed  CAS  Google Scholar 

  21. Gaudino M, Andreotti F, Zamparelli R, Di Castel Nuovo A, Nasso G, Burzotta F, Oacoviello L, Donati MB, Schiavello R, Maseri A, Posati G (2003) The-174G/C interleukin-6 polymorphism influences postoperative interleukin-6 levels and postoperative atrial fibrillation: Is atrial fibrillation an inflammatory complication? Circulation 108:195–199

    Article  CAS  Google Scholar 

  22. Mayr A, Knotzer H, Pajk W, Luckner G, Ritsch N, Dünser M, Ulmer H, Schobersberger W, Haisibeder W (2001) Risk factors associated with new onset tachyarrhythmias after cardiac surgery: a retrospective analysis. Acta Anaesthesiol Scand 45:543–549

    Article  PubMed  CAS  Google Scholar 

  23. Valentin A, Lang T, Karnik R, Ammerer HP, Ploder J, Slany J (2003) Intracranial pressure monitoring and mix-adjusted mortality in intracranial hemorrhage. Crit Care Med 31:1539–1542

    Article  PubMed  Google Scholar 

  24. Amar D, Zhang H, Leung DH, Poistacher N, Kadish AH (2002) Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology 96:352–356

    Article  PubMed  Google Scholar 

  25. Falk RH (2001) Atrial fibrillation. N Engl J Med 344:1067–1078

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Surgical Intensive Care Unit, Hôpital Pontchaillou, 2 rue Henri le Guilloux, Rennes Cedex 9, 35033, Rennes, France

    Philippe Seguin, Axelle Maurice & Yannick Mallédant

  2. Clinical Research Center–Inserm 0203, Hôpital Pontchaillou, 2 rue Henri le Guilloux, Rennes Cedex 9, 35033, Rennes, France

    Bruno Laviolle

  3. Department of Cardiology, Hôpital Pontchaillou, 2 rue Henri le Guilloux, Rennes Cedex 9, 35033, Rennes, France

    Christophe Leclercq

Authors
  1. Philippe Seguin
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  2. Bruno Laviolle
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  3. Axelle Maurice
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  4. Christophe Leclercq
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  5. Yannick Mallédant
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Corresponding author

Correspondence to Philippe Seguin.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-005-0033-1.

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Seguin, P., Laviolle, B., Maurice, A. et al. Atrial fibrillation in trauma patients requiring intensive care. Intensive Care Med 32, 398–404 (2006). https://doi.org/10.1007/s00134-005-0032-2

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  • DOI: https://doi.org/10.1007/s00134-005-0032-2

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