Early markers of acute respiratory distress syndrome development in severe trauma patients

J Crit Care. 2006 Sep;21(3):253-8. doi: 10.1016/j.jcrc.2005.12.012.

Abstract

Purpose: The aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients.

Materials and methods: This was a prospective observational study of 693 severe trauma patients (Injury Severity Score >or=16 and/or Revised Trauma Score <or=11) in 17 hospitals in a Spanish region of 8 million inhabitants from July 2002 to December 2002.

Results: Acute respiratory distress syndrome developed in 6.9% of patients who were more severely ill with higher APACHE II (P < .001) and Injury Severity Score (P = .002) scores vs patients not developing ARDS. Acute respiratory distress syndrome development was associated (P < .001) with fractures of femur (International Classification of Diseases, Ninth Revision [ICD-9] codes 820, 821), tibia (ICD-9 code 823), humerus, and pelvis, with a number (>or=2) of long bone fractures, and with chest injuries (rib/sternal fracture [ICD-9 code 807] and hemo/pneumothorax [ICD-9 code 860/861]). Patients with ARDS required more colloids (P = .005) and red blood cell units (P = .02) than patients without ARDS during the first 24 hours. Multivariate analysis showed that ARDS was related to chest trauma diagnosis (ICD-9 code 807) (odds ratio [OR], 3.85), femoral fracture (OR, 3.16), APACHE II score (OR, 1.05), and blood transfusion during resuscitation (OR, 1.32).

Conclusions: Risk of ARDS development is related to the first 24-hour admission variables, including severe physiologic derangements and specific ICD-9-classified injuries. Blood transfusion may play an independent role.

MeSH terms

  • APACHE
  • Adult
  • Emergency Service, Hospital
  • Female
  • Humans
  • Injury Severity Score
  • Male
  • Prospective Studies
  • Respiratory Distress Syndrome, Adult / epidemiology
  • Respiratory Distress Syndrome, Adult / etiology
  • Respiratory Distress Syndrome, Adult / physiopathology*
  • Risk Factors
  • Wounds and Injuries / complications
  • Wounds and Injuries / physiopathology*