Trauma-adult respiratory distress syndrome.
Sixteen trauma victims with adult respiratory distress syndrome were retrospectively examined. High injury severity score (mean: 44), massive transfusion requirements, and prolonged ventilator days characterize this group. Persistent intra-abdominal infection accounted for two of three deaths in this series. Most of these patients were managed without paralysis using intermittent mandatory ventilation and positive-end expiratory pressure (PEEP). High frequency jet ventilation was necessary in one subject. Two patients exhibited early ARDS reversal, ie, clinical improvement, better chest x-ray and decreased shunt (within 72 hours) when an intra-abdominal septic focus was eradicated. Principles of critical care for these patients remain: an FiO2 less than .40, limiting barotrauma, using PEEP for alveolar recruitment and close monitoring of O2 transport.
Walker
M L
ML
Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia 30335.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications; D005260:Female; D006612:High-Frequency Ventilation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D011175:Positive-Pressure Respiration; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies