Risk Factors for the Development of Acute Respiratory Distress Syndrome Following Hemorrhage

Robinson, Bryce R. H.; Cohen, Mitchell J.; Holcomb, John B.; Pritts, Timothy A.; Gomaa, Dina; Fox, Erin E.; Branson, Richard D.; Callcut, Rachael A.; Cotton, Bryan A.; Schreiber, Martin A.; Brasel, Karen J.; Pittet, Jean–François; Inaba, Kenji; Kerby, Jeffery D.; Scalea, Thomas M.; Wade, Charlie E.; Bulger, Eileen M.

doi:10.1097/shk.0000000000001073

Cited by 47 publications

(45 citation statements)

References 31 publications

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“…In contrast to several studies reporting continuously high ARDS-related deaths [5,[13][14][15][16][17]19], we recently showed low incidence of ARDS and low mortality rates [18]. However, we did observe many polytrauma patients who developed some degree of acute hypoxic respiratory failure (AHRF) without the bilateral diffuse pulmonary infiltrates that characterize ARDS.…”

Section: Introductioncontrasting

confidence: 87%

“…ARDS was defined by the Berlin criteria including bilateral diffuse pulmonary infiltrates on chest X-ray or CT scan (without evidence of heart failure); there are three categories of ARDS based on degree of hypoxemia: grade 1 mild (200 < PaO 2 /FIO 2 ≤ 300), grade 2 moderate (100 < PaO 2 / FIO 2 ≤ 200), and grade 3 severe (PaO 2 /FIO 2 ≤ 100), all with positive end expiratory pressure (PEEP) ≥ 5cmH 2 0 [14]. Worst PaO 2 /FIO 2 ratios were calculated on a daily basis starting from day 1 after trauma.…”

Section: Definitionsmentioning

confidence: 99%

“…Patients with grade 1 hypoxemia spent 7 (4-10) days on the ventilator, 7 (4-13) days in ICU and 24 (15-34) days in hospital. Patients with grade 2 hypoxemia spent 9 (7-14) days on the ventilator, 11 (8)(9)(10)(11)(12)(13)(14)(15)(16) days in ICU and 26 (14-37) days in hospital. Patients with grade 3 hypoxemia spent 13 (7-23) days on the ventilator, 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days in ICU and 32 (17-51) days in hospital (Fig.…”

Section: Pao 2 /Fio 2 Grading Related To Outcomementioning

confidence: 99%

“…Nowadays, the treatment is still limited and mainly consists of supportive mechanical ventilation with low tidal volume and inspiratory pressure ventilation. With improvement of trauma, critical-care mortality caused by ARDS has decreased in the last years [5,[13][14][15][16][17][18]. However, it still uses significant intensive care unit (ICU) resources.…”

Section: Introductionmentioning

confidence: 99%

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Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study

Wessem

Leenen

2019

Eur J Trauma Emerg Surg

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Purpose The definition of acute respiratory distress syndrome (ARDS) has often been modified with Berlin criteria being the most recent. ARDS is divided into three categories based on the degree of hypoxemia using PaO 2 /FiO 2 ratio. Radiological findings are standardized with bilateral diffuse pulmonary infiltrates present on chest imaging. This study investigated whether chest imaging is relevant in diagnosing ARDS in polytrauma patients. Methods The 5-year prospective study included consecutive trauma patients admitted to a Level-1 Trauma Center ICU. Demographics, ISS, physiologic parameters, resuscitation parameters, and ARDS data were prospectively collected. Acute hypoxic respiratory failure (AHRF) was categorized as Berlin criteria without bilateral diffuse pulmonary infiltrates on imaging. Data are presented as median (IQR), p < 0.05 was considered significant. Results 267 patients were included. Median age was 45 (26-59) years, 199 (75%) males, ISS was 29 (22-35), 258 (97%) patients had blunt injuries. Thirty-five (13%) patients died. 192 (72%) patients developed AHRF. AHRF patients were older, more often male, had higher ISS, needed more crystalloids and blood products than patients without AHRF. They developed more pulmonary complications, stayed longer on the ventilator, in ICU and in hospital, and died more often. Fifteen (6%) patients developed ARDS. There was no difference in outcome between ARDS and AHRF patients. Conclusions Many patients developed AHRF and only a few ARDS. Patients with similar hypoxemia without bilateral diffuse pulmonary infiltrates had comparable outcome as ARDS patients. Chest imaging did not influence the outcome. Large-scale multicenter validation of ARDS criteria is warranted to investigate whether diffuse bilateral pulmonary infiltrates on chest imaging could be omitted as a mandatory part of the definition of ARDS in polytrauma patients.

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Section: Introductioncontrasting

confidence: 87%

Section: Definitionsmentioning

confidence: 99%

Section: Pao 2 /Fio 2 Grading Related To Outcomementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study

Wessem

Leenen

2019

Eur J Trauma Emerg Surg

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“…In addition to the potential effects of transfusion therapies, it should also be noted that high crystalloid volumes have recently been associated with an increased incidence of acute respiratory distress syndrome in patients with acute trauma. 37 As our cohort received median intraoperative crystalloid volumes greater than 6 L, with higher volumes observed in those with increased plasma volumes, it is important to note this potential modifier of postoperative outcomes.…”

Section: Discussionmentioning

confidence: 98%

Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

et al. 2018

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Background: Intraoperative plasma transfusion is common, yet little is known regarding its effects on perioperative coagulation tests or clinical outcomes. Study Design and Methods: This is a retrospective cohort study of adults receiving intraoperative plasma transfusion at a single center from 2011–2015. Relationships between plasma transfusion volume, changes in coagulation test values, and clinical outcomes, including a primary outcome of early postoperative RBC transfusion, were assessed with multivariable regression analyses. Secondary outcomes included hospital mortality, ICU and hospital free days, intraoperative RBC transfusions, and estimated blood loss. Results: 3,393 unique patients were included, with median (IQR) transfusion of 2 (2, 4) units. In multivariable analyses, higher plasma volumes were associated with worse outcomes, with each 1 ml/kg increase associated with increased odds for postoperative [1.02 (1.01, 1.03); p<.001] and intraoperative RBCs [1.17 (1.16, 1.19); p<.001], and fewer ICU and hospital free days [mean difference (95% CI) −0.08 (−0.12, −0.05); p < 0.001 and −0.09 (−0.13, −0.06); p < 0.001, respectively]. Greater decreases in INR following plasma transfusion were associated with decreased odds of postoperative RBCs [0.35 (0.25, 0.47); p<.001], decreased mortality [0.50 (0.31, 0.83); p=0.007], and increased mean ICU [1.31 (0.41, 2.21); p=0.004] and hospital free days [1.15 (0.19, 2.10); p=0.018]. Conclusion: In patients receiving intraoperative plasma transfusion, higher transfusion volumes were associated with inferior clinical outcomes; however, greater improvements in INR were associated with improved outcomes. Future prospective studies are necessary to better define these relationships and to explore plasma transfusion triggers beyond the limitations of INR.

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Acute Respiratory Failure and Acute Respiratory Distress Syndrome in ACS Patient: What Are the Indications for Acute Intervention?

Peschman

Moya

2019

Intensive Care for Emergency Surgeons

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Risk Factors for the Development of Acute Respiratory Distress Syndrome Following Hemorrhage

Abstract: Acute crystalloid exposure, but not blood products, is a potentially modifiable risk factor for the prevention of ARDS following hemorrhage.

Cited by 47 publications

References 31 publications

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study

Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study

Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

Acute Respiratory Failure and Acute Respiratory Distress Syndrome in ACS Patient: What Are the Indications for Acute Intervention?

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