创伤患者早期急性呼吸窘迫综合征的临床预测指标
Clinical predictors of early acute respiratory distress syndrome in trauma patients.
作者信息
O'Leary Michael P, Keeley Jessica A, Yule Arthur, Suruki Caitlyn, Plurad David S, Moazzez Ashkan, Neville Angela L, Putnam Brant A, Kim Dennis Y
机构信息
Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA.
Harbor-UCLA Medical Center, Department of Surgery, 1000 West Carson Street Box 461, Torrance, CA 90502, USA.
出版信息
Am J Surg. 2016 Dec;212(6):1096-1100. doi: 10.1016/j.amjsurg.2016.09.008. Epub 2016 Sep 30.
BACKGROUND
The objectives of this study were to examine the incidence and severity of early acute respiratory distress syndrome (ARDS) according to the Berlin Definition and to identify risk factors associated with the development of early post-traumatic ARDS.
METHODS
A 2.5-year retrospective database of adult trauma patients who required mechanical ventilation for greater than 48 hours at a level 1 trauma center was analyzed for variables predictive of early (<48 hours after injury), mild, moderate, and severe ARDS and in-hospital mortality.
RESULTS
Of 305 patients, 59 (19.3%) developed early ARDS: mild, 27 (45.8%); moderate, 26 (44.1%); and severe, 6 (10.1%). Performance of an emergent thoracotomy, blunt mechanism, and fresh frozen plasma administration were independently associated with the development of early ARDS. ARDS was not predictive of mortality.
CONCLUSIONS
Trauma patients with blunt mechanism, who receive fresh frozen plasma, or undergo thoracotomy, are at risk of developing early ARDS.
背景
本研究的目的是根据柏林定义检查早期急性呼吸窘迫综合征（ARDS）的发病率和严重程度，并确定与创伤后早期ARDS发生相关的危险因素。
方法
对一家一级创伤中心需要机械通气超过48小时的成年创伤患者进行了为期2.5年的回顾性数据库分析，以寻找预测早期（受伤后<48小时）、轻度、中度和重度ARDS以及院内死亡率的变量。
结果
在305例患者中，59例（19.3%）发生了早期ARDS：轻度27例（45.8%）；中度26例（44.1%）；重度6例（10.1%）。急诊开胸手术、钝性机制和新鲜冰冻血浆输注与早期ARDS的发生独立相关。ARDS不能预测死亡率。
结论
具有钝性机制、接受新鲜冰冻血浆或接受开胸手术的创伤患者有发生早期ARDS的风险。
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