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Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients.
Crit Care Med. 2004 Feb; 32(2):327-31.CC

Abstract

OBJECTIVE

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are known to be associated with increased mortality and costs in trauma patients. We estimated the independent impact of these conditions on mortality and cost, beyond the severity of injury with which they are correlated.

DESIGN

One-year prospective cohort.

PATIENTS AND SETTING

All trauma patients admitted to the intensive care unit in a level I center were evaluated daily for ALI/ARDS using the American-European Consensus Conference definition.

MEASUREMENTS AND MAIN RESULTS

The main outcome measures were hospital mortality and costs. Logistic regression was used to model hospital mortality in relation to the presence of ALI and ARDS, adjusting for trauma severity (Injury Severity Score), Acute Physiology Score, and age. Hospital costs were modeled using multivariable linear regression. Of the 1,296 trauma patients surviving beyond the first day, 4% experienced ALI (defined as Pao2/Fio2 of 201-300 mm Hg) and 12% had ARDS (Pao2/Fio2 < or = 200 mm Hg). The crude relative risk of mortality was 2.24 (95% confidence interval, 0.92-5.45) in patients with ALI and 3.84 (95% confidence interval, 2.41-6.13) in patients with ARDS compared with those without ALI/ARDS. However, there was no association of mortality with ALI (relative risk, 0.99; 95% confidence interval, 0.29-3.36) or with ARDS (relative risk, 1.23; 95% confidence interval, 0.63-2.43) after adjustment for age, Injury Severity Score, and Acute Physiology Score. Among patients of comparable age, severity score, and length of stay, median cost was 20% to 30% higher for those with ALI/ARDS.

CONCLUSIONS

There is no additional mortality associated with ALI/ARDS above and beyond the factors that can be measured at intensive care unit admission. Therefore, mortality in trauma patients is explained by injury severity at admission and is not affected by the subsequent occurrence of ALI/ARDS. Nonetheless, ALI/ARDS was associated with increased intensive care unit stay and hospital cost, independent of trauma severity.

Authors+Show Affiliations

Department of Medicine, Harborview Medical Center, University of Wshington, Seattle, WA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14758144

Citation

Treggiari, Miriam M., et al. "Effect of Acute Lung Injury and Acute Respiratory Distress Syndrome On Outcome in Critically Ill Trauma Patients." Critical Care Medicine, vol. 32, no. 2, 2004, pp. 327-31.
Treggiari MM, Hudson LD, Martin DP, et al. Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients. Crit Care Med. 2004;32(2):327-31.
Treggiari, M. M., Hudson, L. D., Martin, D. P., Weiss, N. S., Caldwell, E., & Rubenfeld, G. (2004). Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients. Critical Care Medicine, 32(2), 327-31.
Treggiari MM, et al. Effect of Acute Lung Injury and Acute Respiratory Distress Syndrome On Outcome in Critically Ill Trauma Patients. Crit Care Med. 2004;32(2):327-31. PubMed PMID: 14758144.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of acute lung injury and acute respiratory distress syndrome on outcome in critically ill trauma patients. AU - Treggiari,Miriam M, AU - Hudson,Leonard D, AU - Martin,Diane P, AU - Weiss,Noel S, AU - Caldwell,Ellen, AU - Rubenfeld,Gordon, PY - 2004/2/6/pubmed PY - 2004/3/31/medline PY - 2004/2/6/entrez SP - 327 EP - 31 JF - Critical care medicine JO - Crit Care Med VL - 32 IS - 2 N2 - OBJECTIVE: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are known to be associated with increased mortality and costs in trauma patients. We estimated the independent impact of these conditions on mortality and cost, beyond the severity of injury with which they are correlated. DESIGN: One-year prospective cohort. PATIENTS AND SETTING: All trauma patients admitted to the intensive care unit in a level I center were evaluated daily for ALI/ARDS using the American-European Consensus Conference definition. MEASUREMENTS AND MAIN RESULTS: The main outcome measures were hospital mortality and costs. Logistic regression was used to model hospital mortality in relation to the presence of ALI and ARDS, adjusting for trauma severity (Injury Severity Score), Acute Physiology Score, and age. Hospital costs were modeled using multivariable linear regression. Of the 1,296 trauma patients surviving beyond the first day, 4% experienced ALI (defined as Pao2/Fio2 of 201-300 mm Hg) and 12% had ARDS (Pao2/Fio2 < or = 200 mm Hg). The crude relative risk of mortality was 2.24 (95% confidence interval, 0.92-5.45) in patients with ALI and 3.84 (95% confidence interval, 2.41-6.13) in patients with ARDS compared with those without ALI/ARDS. However, there was no association of mortality with ALI (relative risk, 0.99; 95% confidence interval, 0.29-3.36) or with ARDS (relative risk, 1.23; 95% confidence interval, 0.63-2.43) after adjustment for age, Injury Severity Score, and Acute Physiology Score. Among patients of comparable age, severity score, and length of stay, median cost was 20% to 30% higher for those with ALI/ARDS. CONCLUSIONS: There is no additional mortality associated with ALI/ARDS above and beyond the factors that can be measured at intensive care unit admission. Therefore, mortality in trauma patients is explained by injury severity at admission and is not affected by the subsequent occurrence of ALI/ARDS. Nonetheless, ALI/ARDS was associated with increased intensive care unit stay and hospital cost, independent of trauma severity. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/14758144/Effect_of_acute_lung_injury_and_acute_respiratory_distress_syndrome_on_outcome_in_critically_ill_trauma_patients_ L2 - https://dx.doi.org/10.1097/01.CCM.0000108870.09693.42 DB - PRIME DP - Unbound Medicine ER -