Early and late acute respiratory distress syndrome: two distinct clinical entities
| Autor: | Timothy C. Fabian, Kimberly A. Davis, Martin A. Croce, Timothy J. Gavin |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male ARDS medicine.medical_specialty Time Factors Adolescent Multiple Organ Failure Shock Hemorrhagic Age Distribution Injury Severity Score Cause of Death medicine Humans Aged Retrospective Studies Aged 80 and over Respiratory Distress Syndrome medicine.diagnostic_test business.industry Pneumonia Middle Aged medicine.disease Surgery Oxygen Bronchoalveolar lavage Shock (circulatory) Heart failure Anesthesia Wounds and Injuries Female medicine.symptom Blood Gas Analysis Chest radiograph Complication business Capillary Leak Syndrome |
| Zdroj: | The Journal of trauma. 46(3) |
| ISSN: | 0022-5282 |
| Popis: | Background: Despite numerous advances in surgical critical care and ventilatory management, mortality rates for acute respiratory distress syndrome (ARDS) have remained relatively constant. Pressure-limited and non-pressure-limited ventilatory techniques have been advocated with disparate results. We hypothesized that there are two forms of ARDS, which may account for the conflicting clinical reports. Methods: Patients with posttraumatic ARDS were identified and reviewed. ARDS was defined as Pao 2 /Fio 2 ratio less than 200 with diffuse bilateral infiltrates on chest radiograph and no congestive heart failure. Patients were analyzed relative to injury mechanism, transfusions, fluid balance, presence of pneumonia (defined as ≥10 5 colony-forming units/mL in bronchoalveolar lavage effluent), and outcome. All were managed with a non-pressure-limited strategy. Results: During a 5.5-year period, 178 patients with posttraumatic ARDS were identified. Mean Injury Severity Score and age were 29 and 40 years, respectively. Patients were stratified by time of ARDS diagnosis. Eighty-two patients (46%) had early ARDS (within 48 hours after admission), and 96 patients (54%) had late ARDS (>48 hours between admission and diagnosis). There were no differences in Injury Severity Score, but the late group was significantly older. The early ARDS group was characterized by profound hemorrhagic shock and had significant differences from the late group in incidence of penetrating injury (30 vs. 10%; p < 0.001), admission base deficit (-7.7 vs. -4.2 mEq/L; p < 0.001), 48-hour transfusions (19.7 vs. 9.4; p < 0.0001), initial 5-day fluid balance (19.9 vs. 10.1 L; p < 0.0001), and initial Pao 2 /Fio 2 (121 vs. 141; p < 0.007). Pneumonia before ARDS was significantly associated with late ARDS (38 vs. 9%; p < 0.001). ARDS-related mortality was primarily caused by hemorrhagic shock in the early group and progressive multiple organ failure in the late group. Conclusion: There are two distinct forms of posttraumatic ARDS. Early ARDS is characterized by hemorrhagic shock with capillary leak. Late ARDS frequently follows pneumonia and is associated with multiple system injury. Further studies should differentiate between these two distinct syndromes. |
| Databáze: | OpenAIRE |
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