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

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 ≥16 and/or Revised Trauma Score ≤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 (≥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.