Effect of Age on the Development of ARDS in Trauma Patients*

Johnston, Christine; Rubenfeld, Gordon D.; Hudson, Leonard D.

doi:10.1378/chest.124.2.653

Cited by 56 publications

(26 citation statements)

References 28 publications

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“…The average costs for each interval were then multiplied by the probability of dying during the interval to determine weighted costs. (20,21) We used the bootstrap resampling method to obtain percentile-based 95% confidence intervals.…”

Section: Discussionmentioning

confidence: 99%

Long-term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia

Hough

Bansal

Veenstra

2015

Survey of Anesthesiology

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Objective: To assess survival up to 5 years in patients who develop severe acute respiratory distress syndrome (ARDS) and evaluate differences in characteristics and outcomes for patients selected for treatment with a rescue therapy (inhaled nitric oxide, inhaled epoprostenol or prone position ventilation) versus conventional treatment. Design and Setting:Retrospective cohort study of patients admitted to the intensive care unit (ICU) at a 413-bed Level 1 trauma university hospital. Methods: Data were abstracted from the electronic medical record and included demographic and clinical variables, hospital and ICU length of stay, discharge disposition, and hospital costs.We compared patients placed on inhaled nitric oxide, inhaled epoprostenol or ventilated in the prone position with patients treated conventionally. To determine survival beyond hospital discharge, patient-level data were linked to the Washington State Death Registry. Kaplan-Meir survival analysis methods were used to assess survival. Cox's proportional hazards models were used to compare differences in outcomes between patients treated with a rescue therapy and those treated conventionally. Costs were analyzed using the Lin method to estimate mean total costs in the presence of censoring.Main Results: 428 patients meeting the inclusion criteria were identified, of whom 62 (14%) were placed on a rescue therapy. Five-year survival for all patients was 54.9% (95% CI: 50.2%, 60.1%). For patients who were discharged from the hospital alive, 5-year survival was 84.5% (95% CI: 79.8%, 89.4%). Mean hospital cost was $701 K (95% CI: $97K, $846 K). Admission PaO 2 /FIO 2 ratios were similar between patients treated with a rescue therapy and those treated conventionally. However, prior to initiation of rescue therapy, patients treated with a rescue therapy had substantially lower PaO 2 /FIO 2 ratios by 72 hours (54 mm Hg ± 17 versus 69 mm Hg ± 17; p=<.01). The hazard ratio of death up to 5 years following their ICU admission was not different between patients with and without rescue therapy (HR: 1.31, 95% CI: 0.89, 1.94; p = 0.17).Conclusions: Severe ARDS patients surviving to hospital discharge have relatively good longterm survival. Patients with worsening hypoxemia are selected to receive a rescue therapy.Future prospective studies should investigate the impact of the timing of initiation of a rescue therapy prior to the development of life-threatening critical hypoxemia on long-term outcomes.Introduction:

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Section: Discussionmentioning

confidence: 99%

Long-term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia

Hough

Bansal

Veenstra

2015

Survey of Anesthesiology

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“…17,19 Though age is widely accepted as a correlate of the development of acute hypoxemia in trauma patients, the complex interplay of age and ARDS has not been fully elucidated. 20 Given that age is non-modifiable, the role of other modifiable risk factors, like resuscitation, may be even more important for elderly trauma patients and warrants further study.…”

Section: Discussionmentioning

confidence: 99%

Application of the Berlin definition in PROMMTT patients

Cotton

Pritts

Branson

et al. 2013

Journal of Trauma and Acute Care Surgery

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Introduction Acute lung injury following trauma resuscitation remains a concern despite recent advances. Utilizing PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. Methods Patients with survival ≥ 24 hours with at least 1 ICU day were included in the analysis. Hypoxemia was categorized utilizing the Berlin definition for ARDS: none (PaO2 to FiO2 ratio (P/F) > 300 mmHg), mild (P/F = 201–300), moderate (P/F = 101–200) or severe (P/F ≤ 100). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0–6 hours from arrival, late resuscitation was defined as that occurring 7–24 hours. Multivariate logistic regression models were developed controlling for age, gender, mechanisms of injury, arrival physiology, individual AIS scores, blood transfusions and crystalloid administration. Results 58.7% (731/1245) met inclusion criteria. Hypoxemia occurred in 69% (mild 24%, moderate 28%, severe 17%). Mortality was highest (24%) in the severe group. During early resuscitation (0–6 h), logistic regression revealed age (OR 1.02, CI 1.00–1.04), chest AIS (OR 1.31, CI 1.10–1.57) and intravenous crystalloid fluids given in 500 mL increments (OR 1.12 CI 1.01–1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR 1.02, CI 1.00–1.04), chest AIS (OR 1.33, CI 1.11–1.59) and crystalloids given during this period (OR 1.05 CI 1.01–1.10) were also predictive of moderate to severe hypoxemia. RBC, plasma and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. Conclusion Severe chest injury, increasing age and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate to severe hypoxemia following injury. Level of Evidence I

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“…2,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] In addition, we included three informative single-nucleotide polymorphisms of the myosin light chain kinase gene ( MYLK ) that have been shown in our prior studies to be associated with the development of ALI in this trauma population. 15,31 Research coordinators prospectively collected all clinical data on standardized forms.…”

Section: Original Research Critical Care Medicinementioning

confidence: 99%

An Alternative Method of Acute Lung Injury Classification for Use in Observational Studies

Shah

Lanken

Localio

et al. 2010

Chest

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T he diagnoses of acute lung injury (ALI) and its more severe manifestation, ARDS, are based on specifi c clinical and radiographic criteria. 1 The AmericanEuropean Consensus Conference (AECC) standardized these criteria in an effort to improve the systematic identifi cation of patients with this syndrome. This standardization has expedited the recognition of patients with ALI for enrollment into clinical trials and promoted studies on ALI epidemiology by providing a uniform defi nition. [2][3][4][5][6][7] Although the simplicity of the AECC criteria can be advantageous for study inclusion, uncertainties in the fulfi llment of criteria can be especially problematic in epidemiologic studies using ALI as the outcome.High interobserver variability in chest radiograph (CXR) interpretation highlights the uncertainties of ALI classifi cation using the AECC criteria. [8][9][10] Misclassifi cation of subjects with ALI as non-ALI may lead to underestimation of associations between risk factors and ALI. 11 Furthermore, the ALI syndrome may represent a spectrum of injury, and classifi cation of subjects as non-ALI with intermediate forms of lung injury who do not fulfi ll strict ALI criteria may hamper efforts at uncovering novel risk factors, including genetic associations. 12 The purpose of this study was twofold: (1) identify a subset of patients (referred to as equivocal ALI) with diffi cult-to-classify hypoxemic respiratory failure Background: In observational studies using acute lung injury (ALI) as an outcome, a spectrum of lung injury and diffi cult-to-interpret chest radiographs (CXRs) may hamper efforts to uncover risk factor associations. We assessed the impact of excluding patients with diffi cult-to-classify or equivocal ALI diagnosis on clinical and genetic risk factor associations for ALI after trauma. Methods: This study was of a prospective cohort of 280 critically ill trauma patients. The primary outcome was the development of ALI. Patients were classifi ed into one of three groups: (1) definite ALI (patients who fulfi lled the American-European Consensus Conference [AECC] criteria for ALI), (2)equivocal ALI (patients who had diffi cult-to-interpret CXRs), and (3) defi nite non-ALI. We compared clinical and genetic ALI risk factor associations between two classifi cation schemes: AECC classifi cation (defi nite ALI vs rest) and alternative classifi cation (defi nite ALI vs defi nite non-ALI, excluding equivocal ALI). Results: Ninety-three (35%) patients were classifi ed as defi nite ALI, 67 (25%) as equivocal, and 104 (39%) as defi nite non-ALI. Estimates of clinical and genetic ALI risk factor associations were farther from the null using the alternative classifi cation. In a multivariable risk factor model, the C statistic of the alternative classifi cation was signifi cantly higher than that derived from the AECC classifi cation (0.82 vs 0.74; P , .01). Conclusions: The ability to detect ALI risk factors may be improved by excluding patients with equivocal or diffi cult-to-classify ALI. Such analyses m...

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Effect of Age on the Development of ARDS in Trauma Patients*

Cited by 56 publications

References 28 publications

Long-term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia

Long-term Survival in Patients With Severe Acute Respiratory Distress Syndrome and Rescue Therapies for Refractory Hypoxemia

Application of the Berlin definition in PROMMTT patients

An Alternative Method of Acute Lung Injury Classification for Use in Observational Studies

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