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Acute Respiratory Distress Syndrome in the Trauma Intensive Care Unit
Morbid but Not Mortal
Ali Salim, MD;
Matthew Martin, MD;
Constantinos Constantinou, MD;
Burapat Sangthong, MD;
Carlos Brown, MD;
George Kasotakis, MD;
Demetrios Demetriades, MD;
Howard Belzberg, MD
Arch Surg. 2006;141:655-658.
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) (P<.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.
Author Affiliations: Division of Trauma and Critical Care, Department of Surgery, University of Southern California Keck School of Medicine, and Los Angeles County–University of Southern California Medical Center, Los Angeles.
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Prevention and treatment of post-traumatic acute respiratory distress syndrome
Benfield et al.
Trauma 2007;9:255-266.
ABSTRACT
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