Predictive factors of nebulized morphine failure in North-African patients with chest trauma: a prospective pilot study.

Objective: To determine the predictive factors of nebulized morphine (nMOR) failure in patients with chest trauma.

Research design and methods: This was an interventional clinical study. Patients admitted with isolated chest trauma with a pain visual analog score > 4 were included. Each patient received 10 mg nMOR. If pain was still > 4 after 10 minutes of nebulization, the latter was repeated every 10 minutes until pain was relieved (i.e. ≤ 4). If pain was > 4 at 30 minutes, nMOR was considered a failure. Patients were divided into two groups: MOR (+) and MOR (-) (good response to and nMOR failure, respectively).

Results: Seventy-five patients were included. Analysis of the risk factors revealed that road traffic accidents (relative risk (RR): 0.117 [0.031-0.443]; p = 0.002), number of fractured ribs > 4 (RR: 0.317 [0.092-0.543]; p = 0.006), bilateral injury (RR: 0.114 [0.037-0.349]; p < 0.001), flail chest (RR: 0.120 [0.037-0.386]; p < 0.001), hemothorax (RR: 0.203 [0.062-0.660]; p = 0.008), pulmonary contusion (RR: 0.202 [0.069-0.589]; p = 0.003), and pain at admission > 7 (RR: 0.363 [0.147-0.579]; p = 0.004) were predictors of nMOR failure.

Conclusion: Our results can help optimize the analgesic management of chest trauma patients by identifying the most eligible patients to benefit from nMOR.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT03580187.