Does lack of thoracic trauma attenuate the severity of pulmonary failure? An 8-year analysis of critically injured patients
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Patients with thoracic trauma are presumed to be at higher risk for pulmonary dysfunction, but adult respiratory distress syndrome (ARDS) may develop in any patient, regardless of associated chest injury. This study evaluated the impact of thoracic trauma and pulmonary failure on outcomes in trauma patients admitted to the intensive-care unit (ICU).
All trauma patients admitted to the ICU over an 8-year period were identified. Patients that died within 48 h of arrival were excluded. Patients were stratified by baseline characteristics, injury severity, development of ARDS, and infectious complications. Multiple logistic regression was used to determine variables significantly associated with the development of ARDS.
10,362 patients were identified. After exclusions, 4898 (50%) patients had chest injury and 4975 (50%) did not. 200 (2%) patients developed ARDS (3.6% of patients with chest injury and 0.5% of patients without chest injury). Patients with ARDS were more likely to have chest injury than those without ARDS (87% vs 49%, p < 0.001). However, of the patients without chest injury, the development of ARDS still led to a significant increase in mortality compared to those patients without ARDS (58% vs 5%, p < 0.001). Multiple logistic regression found ventilator-associated pneumonia (VAP) to be the only independent predictor for the development of ARDS in ICU patients without chest injury.
ARDS development was more common in patients with thoracic trauma. Nevertheless, the development of ARDS in patients without chest injury was associated with a tenfold higher risk of death. The presence of VAP was found to be the only potentially preventable and treatable risk factor for the development of ARDS in ICU patients without chest injury.
KeywordsARDS Ventilator-associated pneumonia Trauma Chest injury
Study conception and design: Huang and Sharpe. Acquisition of data: Sharpe and Huang. Analysis and interpretation of data: Sharpe, Huang, Magnotti, Fabian, and Croce. Drafting of manuscript: Sharpe and Huang. Critical revision: Magnotti, Fabian, and Croce.
Compliance with ethical standards
Conflict of interest
Xin Huang MD does not have any financial disclosures or conflicts of interest to declare. Louis J Magnotti MD does not have any financial disclosures or conflicts of interest to declare. Timothy C Fabian MD does not have any financial disclosures or conflicts of interest to declare. Martin A Croce MD does not have any financial disclosures or conflicts of interest to declare. John P Sharpe MD, MS does not have any financial disclosures or conflicts of interest to declare.
- 2.Fahr M, Jones G, O’Neal H, Duchesne J, Tatum D. Acute respiratory distress syndrome incidence, but not mortality, has decreased nationwide: a national trauma data bank study. Am Surg. 2017;83(4):323–31.Google Scholar
- 10.Miller PR, Croce MA, Kilgo PD, Scott J, Fabian TC. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg. 2002;68(10):845–50 (discussion 850-1).Google Scholar
- 13.Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, et al. Epidemiology, pattern of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788–800.CrossRefGoogle Scholar
- 14.Poole GV, Ward EF, Griswold JA, Muakkassa FF, Hsu HS. Complications of pelvic fractures from blunt trauma. Am Surg. 1992;58:225–31.Google Scholar
- 20.Magnotti LJ, Schroeppel TJ, Fabian TC, Clement LP, Swanson JM, Fischer PE, Bee TK, Maish GO 3rd, Minard G, Zarzaur BL, Croce MA. Reduction in inadequate empiric antibiotic therapy for ventilator-associated pneumonia: impact of a unit-specific treatment pathway. Am Surg. 2008;74(6):516–22 (discussion 522-3).Google Scholar
- 22.ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307(23):2526–33.Google Scholar
- 23.Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R, et al: The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149(3 pt 1):818–824.CrossRefGoogle Scholar