The online version of this article (https://doi.org/10.1007/s00068-019-01204-3) contains supplementary material, which is available to authorized users.
The definition of acute respiratory distress syndrome (ARDS) has often been modified with Berlin criteria being the most recent. ARDS is divided into three categories based on the degree of hypoxemia using PaO2/FiO2 ratio. Radiological findings are standardized with bilateral diffuse pulmonary infiltrates present on chest imaging. This study investigated whether chest imaging is relevant in diagnosing ARDS in polytrauma patients.
The 5-year prospective study included consecutive trauma patients admitted to a Level-1 Trauma Center ICU. Demographics, ISS, physiologic parameters, resuscitation parameters, and ARDS data were prospectively collected. Acute hypoxic respiratory failure (AHRF) was categorized as Berlin criteria without bilateral diffuse pulmonary infiltrates on imaging. Data are presented as median (IQR), p < 0.05 was considered significant.
267 patients were included. Median age was 45 (26–59) years, 199 (75%) males, ISS was 29 (22–35), 258 (97%) patients had blunt injuries. Thirty-five (13%) patients died. 192 (72%) patients developed AHRF. AHRF patients were older, more often male, had higher ISS, needed more crystalloids and blood products than patients without AHRF. They developed more pulmonary complications, stayed longer on the ventilator, in ICU and in hospital, and died more often. Fifteen (6%) patients developed ARDS. There was no difference in outcome between ARDS and AHRF patients.
Many patients developed AHRF and only a few ARDS. Patients with similar hypoxemia without bilateral diffuse pulmonary infiltrates had comparable outcome as ARDS patients. Chest imaging did not influence the outcome. Large-scale multicenter validation of ARDS criteria is warranted to investigate whether diffuse bilateral pulmonary infiltrates on chest imaging could be omitted as a mandatory part of the definition of ARDS in polytrauma patients.
Supplemental Fig. 1. A. Day of onset of Multiple Organ Dysfunction Syndrome. B. Duration of Multiple Organ Dysfunction Syndrome * some patients had several periods of MODS (EPS 18 kb)68_2019_1204_MOESM1_ESM.eps
Supplemental Fig. 2. A. Individual Denver MOF scores of patients who developed Multiple Organ Dysfunction Syndrome expressed per grade of organ failure and per category of organ failure. B.Order of failing organs related to days after admission (EPS 34 kb)68_2019_1204_MOESM2_ESM.eps
Ranieri VM, Rubenfeld GD, Thompson BT, et al. ARDS definition task force. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526–33. PubMed
Daher P, Teixeira PG, Coopwood TB, Brown LH, Ali S, Aydelotte JD, et al. Mild to moderate to severe: what drives the severity of ARDS in trauma patients? Am Surg. 2018;6:808–12.
Park PK, Cannon JW, Ye W, Blackbourne LH, Holcomb JB, Beninati W, Napolitano LM. Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care. J Trauma Acute Care Surg. 2016; 81 (5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S150–6.
Robinson BRH, Cohen MJ, Holcomb JB, Pritts TA, Gomaa D, Fox EE, Branson RD, Callcut RA, Cotton BA, Schreiber MA, Brasel KJ, Pittet JF, Inaba K, Kerby JD, Scalea TM, Wade CE, Bulger EM, PROPPR Study Group. Risk factors for the development of acute respiratory distress syndrome following hemorrhage. Shock. 2018;50(3):258–64. https://doi.org/10.1097/shk.0000000000001073. CrossRefPubMed
Zielinski MD, Jenkins D, Cotton BA, Inaba K, Vercruysse G, Coimbra R, Brown CV, Alley DE, DuBose J, Scalea TM, AAST Open Abdomen Study Group. Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy: AAST multicenter post hoc analysis. J Trauma Acute Care Surg. 2014;77(6):886–91. https://doi.org/10.1097/ta.0000000000000421. CrossRefPubMed
Laffey JG, Kavanagh BP. Negative trials in critical care: why most research is probably wrong. Lancet Respir Med. 2018;6(9):659–60. https://doi.org/10.1016/S2213-2600(18)30279-0 (epub 27 Jul 2018). CrossRefPubMed
- Is chest imaging relevant in diagnosing acute respiratory distress syndrome in polytrauma patients? A population-based cohort study
Karlijn Julia Patricia van Wessem
Luke Petrus Hendrikus Leenen
- Springer Berlin Heidelberg
European Journal of Trauma and Emergency Surgery
Official Publication of the European Society for Trauma and Emergency Surgery
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II