TY - JOUR
T1 - Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy
T2 - AAST multicenter post hoc analysis
AU - Zielinski, Martin D.
AU - Jenkins, Donald
AU - Cotton, Bryan A.
AU - Inaba, Kenji
AU - Vercruysse, Gary
AU - Coimbra, Raul
AU - Brown, Carlos V.R.
AU - Alley, Darrell E.R.
AU - DuBose, Joseph
AU - Scalea, Thomas M.
AU - Shrestha, B.
AU - Holcomb, J.
AU - Okoye, O.
AU - Konstantinidis, A.
AU - Menaker, J.
AU - Whelan, J. F.
AU - Ivatury, R.
AU - Goldberg, S. R.
AU - Ballman, K. V.
AU - Harmsen, W. S.
AU - Rowe, S.
AU - Alley, D.
AU - Berne, J.
AU - Allen, L.
AU - Pieri, PG
AU - Haney, S.
AU - Claridge, J. A.
AU - Kelly, K.
AU - Bee, T.
AU - Fabian, T.
AU - Doucet, J.
AU - Coopwood, B.
AU - Keith, D.
AU - Brown, C.
AU - Haan, J. M.
AU - Ward, J.
AU - Leon, S. M.
AU - Eriksson, E.
AU - Couillard, D.
AU - de Moya, M. A.
AU - van der Wilden, G. M.
N1 - Publisher Copyright:
© 2014 Lippincott Williams & Wilkins.
PY - 2014/12/11
Y1 - 2014/12/11
N2 - Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78% men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14%). Overall mortality was 23%, with a 39% mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95% confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95% CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95% CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95% CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95% CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.
AB - Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78% men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14%). Overall mortality was 23%, with a 39% mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95% confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95% CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95% CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95% CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95% CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.
KW - Adult respiratory distress syndrome
KW - Damage control
KW - Laparotomy
KW - Open abdomen
KW - Trauma
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U2 - 10.1097/TA.0000000000000421
DO - 10.1097/TA.0000000000000421
M3 - Article
C2 - 25248057
AN - SCOPUS:84918512971
SN - 2163-0755
VL - 77
SP - 886
EP - 891
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 6
ER -