使用柏林定义的重度创伤性脑损伤中急性呼吸窘迫综合征（ARDS）的发病率及相关死亡率。
The incidence of ARDS and associated mortality in severe TBI using the Berlin definition.
作者信息
Aisiku Imoigele P, Yamal Jose-Miguel, Doshi Pratik, Rubin Maria Laura, Benoit Julia S, Hannay Julia, Tilley Barbara C, Gopinath Shankar, Robertson Claudia S
机构信息
From the Department of Emergency Medicine (I.P.A.), Brigham and Women's Hospital, Boston, Massachusetts; and Division of Biostatistics (J.M.-Y., M.L.R., B.C.T.), University of Texas School of Public Health; Department of Emergency Medicine and Internal Medicine (P.D.), University of Texas Health Science Center at Houston; Department of Basic Vision Sciences (J.S.B.), College of Optometry Texas Institute for Measurement Evaluation and Statistics, and Department of Psychology (J.H.), University of Houston; and Department of Neurosurgery (S.G., C.S.R.), Baylor College of Medicine, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2016 Feb;80(2):308-12. doi: 10.1097/TA.0000000000000903.
BACKGROUND
The incidence of adult respiratory distress syndrome (ARDS) in severe traumatic brain injury (TBI) is poorly reported. Recently, a new definition for ARDS was proposed, the Berlin definition. The percentage of patients represented by TBI in the Berlin criteria study is limited. This study describes the incidence and associated mortality of ARDS in TBI patients.
METHODS
The study was an analysis of the safety of erythropoietin administration and transfusion threshold on the incidence of ARDS in severe TBI patients. Three reviewers independently assessed all patients enrolled in the study for acute lung injury/ARDS using the Berlin and the American-European Consensus Conference (AECC) definitions. A Cox proportional hazards model was used to assess the relationship between ARDS and mortality and 6-month Glasgow Outcome Scale (GOS) score.
RESULTS
Two hundred patients were enrolled in the study. Of the patients, 21% (41 of 200) and 26% (52 of 200) developed ARDS using the AECC and Berlin definitions, respectively, with a median time of 3 days (interquartile range, 3) after injury. ARDS by either definition was associated with increased mortality (p = 0.04) but not with differences in functional outcome as measured by the GOS score at 6 months. Adjusted analysis using the Berlin criteria showed an increased mortality associated with ADS (p = 0.01).
CONCLUSION
Severe TBI is associated with an incidence of ARDS ranging from 20% to 25%. The incidence is comparable between the Berlin and AECC definitions. ARDS is associated with increased mortality in severe TBI patients, but further studies are needed to validate these findings.
LEVEL OF EVIDENCE
Epidemiologic study, level II.
背景
严重创伤性脑损伤（TBI）中成人呼吸窘迫综合征（ARDS）的发病率报道较少。最近，提出了ARDS的新定义——柏林定义。在柏林标准研究中，TBI患者所占的比例有限。本研究描述了TBI患者中ARDS的发病率及相关死亡率。
方法
本研究分析了促红细胞生成素给药安全性及输血阈值对严重TBI患者ARDS发病率的影响。三位评审员独立使用柏林定义和欧美共识会议（AECC）定义评估纳入研究的所有患者是否发生急性肺损伤/ARDS。采用Cox比例风险模型评估ARDS与死亡率以及6个月格拉斯哥预后量表（GOS）评分之间的关系。
结果
200例患者纳入本研究。分别采用AECC定义和柏林定义时，21%（200例中的41例）和26%（200例中的52例）的患者发生ARDS，伤后中位时间为3天（四分位间距，3天）。无论采用哪种定义，ARDS均与死亡率增加相关（p = 0.04），但与6个月时用GOS评分衡量的功能结局差异无关。采用柏林标准进行的校正分析显示，ARDS与死亡率增加相关（p = 0.01）。
结论
严重TBI与20%至25%的ARDS发病率相关。柏林定义和AECC定义的发病率相当。ARDS与严重TBI患者死亡率增加相关，但需要进一步研究来验证这些发现。
证据级别
流行病学研究，二级。
Zotero 插件