Department of Trauma Surgery, University Medical Center Utrecht, Suite G04.232, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Eur J Trauma Emerg Surg. 2020 Dec;46(6):1393-1402. doi: 10.1007/s00068-019-01204-3. Epub 2019 Aug 10.
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 PaO/FiO 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.
急性呼吸窘迫综合征（ARDS）的定义经常被修改，柏林标准是最新的标准。ARDS 根据 PaO/FiO 比值分为三个低氧血症程度的类别。放射学表现通过胸部影像学上存在双侧弥漫性肺浸润来标准化。本研究探讨了胸部影像学在诊断多发伤患者 ARDS 中的相关性。
这项 5 年前瞻性研究纳入了连续入住一级创伤中心 ICU 的创伤患者。前瞻性收集了人口统计学、ISS、生理参数、复苏参数和 ARDS 数据。急性低氧性呼吸衰竭（AHRF）分为无影像学双侧弥漫性肺浸润的柏林标准。数据以中位数（IQR）表示，p<0.05 为差异有统计学意义。
共纳入 267 例患者。中位年龄为 45（26-59）岁，199 例（75%）为男性，ISS 为 29（22-35），258 例（97%）为钝器伤。35 例（13%）患者死亡。192 例（72%）患者发生 AHRF。AHRF 患者年龄更大，更常为男性，ISS 更高，需要更多晶体液和血液制品。他们发生更多的肺部并发症，呼吸机使用时间、ICU 住院时间和住院时间更长，死亡率更高。15 例（6%）患者发展为 ARDS。ARDS 和 AHRF 患者的结局无差异。
许多患者发生 AHRF，只有少数患者发生 ARDS。类似低氧血症但无双侧弥漫性肺浸润的患者与 ARDS 患者的结局相当。胸部影像学未影响结局。需要进行大规模多中心 ARDS 标准验证，以研究在多发伤患者中，胸部影像学上的弥漫性双侧肺浸润是否可以省略为 ARDS 定义的强制性部分。
