Determinants of early adult respiratory distress syndrome. A retrospective study of 220 patients with major fractures.

The records of 220 consecutive trauma patients admitted to intensive care in the period 1974 through 1982 were reviewed in an attempt to find determinants of early adult respiratory distress syndrome (ARDS). All the patients were considered to be at risk of ARDS and had major fractures without concomitant severe injuries to brain, chest or abdomen. No patient died. ARDS developed in 27 patients (12.3%), on average in the second day post-trauma. The clinical determinants of post-traumatic ARDS were high fracture index, implying severe tissue trauma, and shock on admission. Fluid overload was not found to cause ARDS. Conventional signs of disseminated intravascular coagulation (DIC) were not predictive or diagnostic of ARDS, but were related to the transfused amount of stored blood. Chest radiography was indicative of ARDS in 21 cases, but in six it was normal despite hypoxaemia. In the cases with radiographic signs of ARDS there was generally good chronologic correspondence with hypoxaemia. Ventilation with positive end-expiratory pressure may prevent the classic radiographic picture of ARDS with alveolar densities.