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

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 pu...

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Autores principales: van Wessem, Karlijn Julia Patricia, Leenen, Luke Petrus Hendrikus
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689641/
https://www.ncbi.nlm.nih.gov/pubmed/31401658
http://dx.doi.org/10.1007/s00068-019-01204-3
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author van Wessem, Karlijn Julia Patricia
Leenen, Luke Petrus Hendrikus
author_facet van Wessem, Karlijn Julia Patricia
Leenen, Luke Petrus Hendrikus
author_sort van Wessem, Karlijn Julia Patricia
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00068-019-01204-3) contains supplementary material, which is available to authorized users.
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spelling pubmed-76896412020-11-27 Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study van Wessem, Karlijn Julia Patricia Leenen, Luke Petrus Hendrikus Eur J Trauma Emerg Surg Original Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00068-019-01204-3) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2019-08-10 2020 /pmc/articles/PMC7689641/ /pubmed/31401658 http://dx.doi.org/10.1007/s00068-019-01204-3 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
van Wessem, Karlijn Julia Patricia
Leenen, Luke Petrus Hendrikus
Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
title Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
title_full Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
title_fullStr Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
title_full_unstemmed Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
title_short Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
title_sort is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? a population-based cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689641/
https://www.ncbi.nlm.nih.gov/pubmed/31401658
http://dx.doi.org/10.1007/s00068-019-01204-3
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