Acute Respiratory Distress Syndrome in the Trauma Intensive Care Unit

Abstract

Hypothesis: The diagnosis of acute respiratory distress syndrome (ARDS) carries significant additional morbidity and mortality among critically injured patients. Design: Retrospective case-control study using a prospectively maintained ARDS database. Setting: Surgical intensive care unit (ICU) in an academic county hospital. Patients: All trauma patients admitted to the ICU from January 1, 2000, to December 31, 2003, who developed ARDS as defined by (1) acute onset, (2) a partial pressure of arterial oxygen-fraction of inspired oxygen ratio of 200 or less, (3) bilateral pulmonary infiltrates on chest radiographs, and (4) absence of left-sided heart failure. Each patient with ARDS was matched with 2 control patients without ARDS on the basis of sex, age (±5 years), mechanism of injury (blunt or penetrating), Injury Severity Score (±3), and chest Abbreviated Injury Score (±1). Main Outcome Measures: Mortality, hospital charges, hospital and ICU lengths of stay, and complications (defined as pneumonia, deep venous thrombosis, pulmonary embolism, acute renal failure, and disseminated intravascular coagulopathy). Results: Of 2042 trauma ICU admissions, 216 patients (10.6%) met criteria for ARDS. We identified 432 similarly injured control patients. Compared with controls, trauma patients with ARDS had more complications (43.1% vs 9.5%), longer hospital (32.2 vs 17.9 days) and ICU (22.1 vs 8.4 days) lengths of stay, and higher hospital charges ($267 037 vs $136 680) (PϽ.01 for all), but mortality was similar (27.8% vs 25.0%, P=.48). Conclusion: Although ARDS is associated with increased morbidity, hospital and ICU length of stay, and costs, it does not increase overall mortality among critically ill trauma patients.

Prone Ventilation in Trauma or Surgical Patients With Acute Lung Injury and Adult Respiratory Distress Syndrome: is it Beneficial?

“…4,6,7 A recent study of ARDS in trauma patients reported a mortality rate of 28%. 35 The overall mortality rate in the present study, with the use of prone or supine kinetic therapy, was 30%, but was only 19% when deaths from head injury were excluded. This study also demonstrated a modest survival benefit to prone versus supine positioning with kinetic therapy.…”

Factors influencing lengths of stay in the intensive care unit for surviving trauma patients: a retrospective analysis of 30,157 cases

“…ARDS increases the median duration of mechanical ventilation [37], which can be correlated with longer ICU stays. In trauma patients, ARDS is associated with longer hospital and ICU LOS, and increased morbidity, as well as costs, whereas mortality is not affected [38]. In blunt trauma, independent risk factors for ARDS were ISS ≥25, pulmonary contusion, age ≥65 years, hypotension on admission and massive transfusion [39].…”

Benchmarking Outcomes in the Critically Injured Burn Patient

“…Similar effects have recently been noted in the trauma literature as a decrease in the incidence, morbidity, and mortality of ARDS in the trauma population. 18–20 Previous modes of ventilatory support were shown to incite barotrauma and accentuate the host inflammatory response, which likely compounded the initial damage caused by inhalation injury.…”