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Intensive Care Medicine

, Volume 27, Issue 7, pp 1133–1140 | Cite as

Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization

  • Pedro Navarrete-Navarro
  • Aurelio Rodriguez
  • Neal Reynolds
  • Robert West
  • Nader Habashi
  • Ricardo Rivera
  • William C. Chiu
  • Thomas Scalea
Original

Abstract.

Objective: To evaluate trends in mortality and related factors among trauma patients who developed acute respiratory distress syndrome (ARDS). Study: Observational study based on data prospectively gathered in computerized trauma registry. Setting: Trauma intensive care unit (ICU) of 48 beds in level I trauma center. Patients: All trauma patients with ARDS admitted during 1985–87 (486, group 1 [G1]) and 1993–95 (552, group 2[G2]). Methods: ARDS was defined by American-European Consensus Conference criteria and the need for 48 h or more on mechanical ventilation with FI02 greater than 0.50 and PEEP of more than 5 cmH20. Demographics, severity score, injury-admission delay time, first 24-h transfusion and septic and organ system failure complications were independent variables. ICU mortality was the dependent variable. ICU length of stay (LOS) and life support techniques were considered. Respiratory and renal support strategies were different in the two time periods. Results: Mortality decreased over the period (G1: 29.2% vs G2: 21.4%, p<0.04), in patients aged both over and under 65 years. Multivariate analysis showed mortality was related to age, severity and time period (G1 1.68-fold that in G2) and that the greater G1 mortality was related to more renal failure and hematologic failure/dysfunction. ICU LOS decreased from 31.7±26.7 days (G1) to 27.3±22 days (G2) (p<0.003). Conclusions: Mortality among trauma patients with ARDS declined over the 8 years studied and was associated with less organ failure. This reduction was probably the result of new approaches to mechanical ventilation, renal failure replacement and vasoactive drug therapy.

Trauma Acute respiratory distress syndrome (ARDS) Epidemiology Septic complications Mortality Risk factors Predictors Resource utilization Length of stay Active life support 

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Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • Pedro Navarrete-Navarro
    • 1
  • Aurelio Rodriguez
    • 2
  • Neal Reynolds
    • 2
  • Robert West
    • 2
  • Nader Habashi
    • 2
  • Ricardo Rivera
    • 1
  • William C. Chiu
    • 2
  • Thomas Scalea
    • 2
  1. 1.Critical Care and Emergency Department, Hospital de Traumatología, Virgen de las Nieves University Hospital, Carretera de Jaén s/n, 18014 Granada, SpainSpain
  2. 2.Departments of Critical Care and Trauma Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USAUSA

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