Received: 27 August 2002 Accepted: 17 April 2003 Published online: 12 June 2003 © Springer-Verlag 2003 Abstract Objective: To identify predictors of prolonged (>7 days) mechanical ventilation (MV) in pa- tients with blunt thoracic trauma. Design: Prospective analysis of con- secutive patients. Setting: Adult in- tensive care unit (ICU) in a teaching, tertiary-care hospital. Patients and participants: Sixty-nine patients (53 men, 16 women) with thoracic trauma having a median age of 35 (range 17–85) years and a median injury severity score (ISS) of 29 (range 14–41) were enrolled in the present study. Associated injuries included head–neck (77%), extremi- ties (72%), external (67%), abdo- men–pelvis (67%), and face (55%). Interventions: Patient surveillance and data collection. Measurements and results: Thirty-three (48%) of the 69 patients required prolonged ventilatory support, ranging in dura- tion from 8 to 38 (median 18) days. Logistic regression analysis revealed that advancing age (odds ratio=1.04, p=0.04), severity of head injury (odds ratio=1.92, p=0.008), and bilateral thoracic injuries (odds ratio=12.80, p<0.0001) were signifi- cant and independent predictors of long-lasting MV. In contrast, gender, injuries affecting the other body regions (face, abdomen–pelvis, ex- tremities, and external), laparotomy in patients with abdominal injury, or PaO 2 /FIO 2 on admission in the ICU, were unrelated to prolonged MV. Conclusions: In thoracic trauma patients admitted in the ICU, pro- longed mechanical ventilation was primarily determined by presence of bilateral chest injuries, age, and degree of neurotrauma. This infor- mation may help in planning the long-term care of such patients. Keywords Thoracic trauma · Mechanical ventilation · Duration · Prediction · Bilateral chest injuries · Severe head trauma · Aging Intensive Care Med (2003) 29:1101–1105 DOI 10.1007/s00134-003-1813-0 ORIGINAL Ioanna Dimopoulou Anastasia Anthi Michalis Lignos Efstratios Boukouvalas Evangelos Evangelou Christina Routsi Konstantinos Mandragos Charis Roussos Prediction of prolonged ventilatory support in blunt thoracic trauma patients Introduction The importance of thoracic injury is well recognized. It is involved in nearly one third of acute admissions to trauma centers and is the second most common cause of death after head injury, accounting for approximately 25% of all trauma-related deaths. In the civilian popula- tion, blunt chest trauma largely exceeds penetrating trau- ma [1]. Mechanical ventilation remains the mainstay of live- saving therapy in patients with severe thoracic trauma. Clinical experience suggests that a subset of these pa- tients require prolonged ventilatory support. Predictive criteria for long-lasting mechanical ventilation (MV) in the polytraumatized critically ill have been extensively investigated [2, 3, 4, 5], but no study has specifically ad- dressed this issue in thoracic trauma patients. Early identification of patients who may stay for lon- ger periods under artificial ventilation can be useful in many ways. Important therapeutic decisions can be made, including earlier placement of tracheostomy, which has been proven beneficial in trauma patients [6, I. Dimopoulou · M. Lignos E. Evangelou · C. Routsi · C. Roussos Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece A. Anthi · E. Boukouvalas · K. Mandragos Intensive Care Unit, Hellenic Red Cross Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece I. Dimopoulou ( ✉ ) 2 Pesmazoglou Street, 14 561 Kifissia, Athens, Greece e-mail: idimo@otenet.gr Tel.: +32-10-6200663 Fax: +32-10-6202939