Predictors of postinjury acute respiratory distress syndrome: Lung injury persists in the era of hemostatic resuscitation

急性呼吸窘迫综合征 医学 吸入氧分数 损伤严重程度评分 复苏 插管 麻醉 创伤中心 钝伤 外科 内科学 机械通风 回顾性队列研究 毒物控制 急诊医学 伤害预防
作者
Lucy Z. Kornblith,Anamaria J. Robles,Amanda S. Conroy,Brittney J. Redick,Benjamin M. Howard,Carolyn M. Hendrickson,Sara Moore,Mary F. Nelson,Farzad Moazed,Rachael A. Callcut,Carolyn S. Calfee,Mitchell J. Cohen
出处
期刊:The journal of trauma and acute care surgery [Lippincott Williams & Wilkins]
卷期号:87 (2): 371-378 被引量:18
标识
DOI:10.1097/ta.0000000000002331
摘要

BACKGROUND Acute respiratory distress syndrome (ARDS) following trauma is historically associated with crystalloid and blood product exposure. Advances in resuscitation have occurred over the last decade, but their impact on ARDS is unknown. We sought to investigate predictors of postinjury ARDS in the era of hemostatic resuscitation. METHODS Data were prospectively collected from arrival to 28 days for 914 highest-level trauma activations who required intubation and survived more than 6 hours from 2005 to 2016 at a Level I trauma center. Patients with ratio of partial pressure of oxygen to fraction of inspired oxygen of 300 mmHg or less during the first 8 days were identified. Two blinded expert clinicians adjudicated all chest radiographs for bilateral infiltrates in the first 8 days. Those with left-sided heart failure detected were excluded. Multivariate logistic regression was used to define predictors of ARDS. RESULTS Of the 914 intubated patients, 63% had a ratio of partial pressure of oxygen to fraction of inspired oxygen of 300 or less, and 22% developed ARDS; among the ARDS cases, 57% were diagnosed early ( in the first 24 hours), and 43% later. Patients with ARDS diagnosed later were more severely injured (ISS 32 vs. 20, p = 0.001), with higher rates of blunt injury (84% vs. 72%, p = 0.008), chest injury (58% vs. 36%, p < 0.001), and traumatic brain injury (72% vs. 48%, p < 0.001) compared with the no ARDS group. In multivariate analysis, head/chest Abbreviated Injury Score scores, crystalloid from 0 to 6 hours, and platelet transfusion from 0 to 6 hours and 7 to 24 hours were independent predictors of ARDS developing after 24 hours. CONCLUSIONS Blood and plasma transfusion were not independently associated with ARDS. However, platelet transfusion was a significant independent risk factor. The role of platelets warrants further investigation but may be mechanistically explained by lung injury models of pulmonary platelet sequestration with peripheral thrombocytopenia. LEVEL OF EVIDENCE Prognostic study, level IV.
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