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Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population

BACKGROUND: The incidence of acute respiratory distress syndrome (ARDS) has decreased in the last decade by improvement in trauma and critical care. However, it still remains a major cause of morbidity and mortality. This study investigated the current incidence and mortality of ARDS in polytrauma p...

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Autores principales: van Wessem, Karlijn J P, Leenen, Luke P H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307585/
https://www.ncbi.nlm.nih.gov/pubmed/30623025
http://dx.doi.org/10.1136/tsaco-2018-000232
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author van Wessem, Karlijn J P
Leenen, Luke P H
author_facet van Wessem, Karlijn J P
Leenen, Luke P H
author_sort van Wessem, Karlijn J P
collection PubMed
description BACKGROUND: The incidence of acute respiratory distress syndrome (ARDS) has decreased in the last decade by improvement in trauma and critical care. However, it still remains a major cause of morbidity and mortality. This study investigated the current incidence and mortality of ARDS in polytrauma patients. METHODS: A 4.5-year prospective study included consecutive trauma patients admitted to a level 1 trauma center intensive care unit (ICU). Isolated head injuries, drowning, asphyxiation, burns, and deaths <48 hours were excluded. Demographics, Injury Severity Score (ISS), physiologic parameters, resuscitation parameters, Denver Multiple Organ Failure scores, and ARDS data according to Berlin criteria were prospectively collected. Data are presented as median (IQR), and p<0.05 was considered significant. RESULTS: 241 patients were included. The median age was 45 (27–59) years, 178 (74%) were male, the ISS was 29 (22–36), and 232 (96%) patients had blunt injuries. Thirty-one patients (13%) died. Fifteen patients (6%) developed ARDS. The median time to ARDS onset was 3 (2–5) days after injury. The median duration of ARDS was 2.5 (1–3.5) days. All patients with ARDS were male compared with 61% of non-ARDS patients (p=0.003). Patients who developed ARDS had higher ISS (30 vs. 25, p=0.01), lower Partial Pressure of Oxygen in arterial blood (PaO(2)) both in the emergency department and ICU, and higher Partial Pressure of Carbon Dioxide in arterial blood (PaCo(2)) in the ICU. Patients with ARDS needed more crystalloids <24 hours (8.7 vs. 6.8 L, p=0.03), received more fresh frozen plasma <24 hours (3 vs. 0 U, p=0.04), and more platelet <8 hours and <24 hours. Further, they stayed longer on the ventilator (11 vs. 2 days, p<0.001), longer in the ICU (12 vs. 3 days, p<0.001), and in the hospital (33 vs. 15 days, p=0.004). Patients with ARDS developed more often multiple organ dysfunction syndrome (40% vs. 3%, p<0.001) and died more often (20% vs. 3%, p=0.01). Only one patient with ARDS (7%) died of ARDS. DISCUSSION: In this polytrauma population mortality was predominantly caused by brain injury. The incidence of ARDS was low; its presentation was only early onset, during a short time period, and accompanied by low mortality. LEVEL OF EVIDENCE: Level III.
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spelling pubmed-63075852019-01-08 Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population van Wessem, Karlijn J P Leenen, Luke P H Trauma Surg Acute Care Open 4th World Trauma Congress Article BACKGROUND: The incidence of acute respiratory distress syndrome (ARDS) has decreased in the last decade by improvement in trauma and critical care. However, it still remains a major cause of morbidity and mortality. This study investigated the current incidence and mortality of ARDS in polytrauma patients. METHODS: A 4.5-year prospective study included consecutive trauma patients admitted to a level 1 trauma center intensive care unit (ICU). Isolated head injuries, drowning, asphyxiation, burns, and deaths <48 hours were excluded. Demographics, Injury Severity Score (ISS), physiologic parameters, resuscitation parameters, Denver Multiple Organ Failure scores, and ARDS data according to Berlin criteria were prospectively collected. Data are presented as median (IQR), and p<0.05 was considered significant. RESULTS: 241 patients were included. The median age was 45 (27–59) years, 178 (74%) were male, the ISS was 29 (22–36), and 232 (96%) patients had blunt injuries. Thirty-one patients (13%) died. Fifteen patients (6%) developed ARDS. The median time to ARDS onset was 3 (2–5) days after injury. The median duration of ARDS was 2.5 (1–3.5) days. All patients with ARDS were male compared with 61% of non-ARDS patients (p=0.003). Patients who developed ARDS had higher ISS (30 vs. 25, p=0.01), lower Partial Pressure of Oxygen in arterial blood (PaO(2)) both in the emergency department and ICU, and higher Partial Pressure of Carbon Dioxide in arterial blood (PaCo(2)) in the ICU. Patients with ARDS needed more crystalloids <24 hours (8.7 vs. 6.8 L, p=0.03), received more fresh frozen plasma <24 hours (3 vs. 0 U, p=0.04), and more platelet <8 hours and <24 hours. Further, they stayed longer on the ventilator (11 vs. 2 days, p<0.001), longer in the ICU (12 vs. 3 days, p<0.001), and in the hospital (33 vs. 15 days, p=0.004). Patients with ARDS developed more often multiple organ dysfunction syndrome (40% vs. 3%, p<0.001) and died more often (20% vs. 3%, p=0.01). Only one patient with ARDS (7%) died of ARDS. DISCUSSION: In this polytrauma population mortality was predominantly caused by brain injury. The incidence of ARDS was low; its presentation was only early onset, during a short time period, and accompanied by low mortality. LEVEL OF EVIDENCE: Level III. BMJ Publishing Group 2018-12-19 /pmc/articles/PMC6307585/ /pubmed/30623025 http://dx.doi.org/10.1136/tsaco-2018-000232 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle 4th World Trauma Congress Article
van Wessem, Karlijn J P
Leenen, Luke P H
Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
title Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
title_full Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
title_fullStr Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
title_full_unstemmed Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
title_short Incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
title_sort incidence of acute respiratory distress syndrome and associated mortality in a polytrauma population
topic 4th World Trauma Congress Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307585/
https://www.ncbi.nlm.nih.gov/pubmed/30623025
http://dx.doi.org/10.1136/tsaco-2018-000232
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