Acute lung injury in isolated traumatic brain injury.
OBJECTIVE
To determine the incidence of acute lung injury (ALI) in comatose patients after isolated traumatic brain injury, to determine whether specific brain lesions diagnosed by cranial computed tomographic scans are associated with ALI, and to determine the outcome of patients with head injuries who developed ALI.


METHODS
Descriptive epidemiology and a case-control study using the Traumatic Coma Data Bank was performed to evaluate clinical features and brain lesions associated with ALI in patients with isolated head trauma. Patients with ALI were defined as those who demonstrated a ratio of partial pressure of arterial oxygen to fractional expired oxygen of 300 or less.


RESULTS
Twenty of 100 comatose patients developed ALI. Patients with ALI were almost three times more likely to die or survive in a vegetative state (odds ratio, 2.8; 95% confidence interval, 1.6-4.9). Specific anatomic brain lesions diagnosed by cranial computed tomographic scans were not associated with ALI. However, patients with more severe injuries, i.e., large nonevacuated mass lesions, and those with midline shift demonstrated a 10- and 5-fold increased risk of ALI (odds ratio, 9.9; 95% confidence interval, 1.2-217.1; and odds ratio, 5.5; 95% confidence interval, 1.5-20.0).


CONCLUSIONS
ALI was common in comatose victims with an isolated traumatic brain injury and was associated with an increased risk of death or a severe neurological morbidity. ALI was associated with the global severity of head injury but not with specific anatomic lesions diagnosed by cranial computed tomographic scans.
Bratton
S L
SL
Department of Anesthesiology and Pediatric Critical Care, School of Medicine, University of Washington, Seattle 98105, USA.
Davis
R L
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007223:Infant; D007427:Intracranial Pressure; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome
D010100:Oxygen