ARDS in patients with thermal injury.
OBJECTIVE
To determine the time to onset of the adult respiratory distress syndrome (ARDS) in patients with thermal injury requiring mechanical ventilation. Secondarily, to consider the burn-related risk factors, demographics, incidence, and mortality for ARDS in this population.


METHODS
Retrospective chart review; ARDS defined according to the American-European Consensus Conference and the Lung Injury Severity Score definitions.


METHODS
Regional, tertiary referral, adult burn unit in a university teaching hospital.


METHODS
Patients with thermal injury requiring mechanical ventilation, admitted between 1 January 1991 and 28 February 1995.


METHODS
None.


RESULTS
Of 469 consecutive admissions, 126 (26.9%) received intubation and mechanical ventilation. ARDS was defined according to the American-European Consensus and Lung Injury Severity Score (score > 2.5) definitions. The mean time to onset of ARDS from admission to the burn unit was 6.9 +/- 5.2 and 8.2 +/- 10.7 days when defined by the American-European Consensus and Lung Injury Severity Score definitions respectively (p = 0.41). Of the intubated patients, 53.6 and 45.2% developed ARDS according to the American-European Consensus and Lung Injury Severity Score definitions, respectively (p = 0.19). Using multivariate logistic analysis, only age proved to be an independent risk factor for the development of ARDS (p = 0.03), although there was a trend toward an increased incidence of inhalation injury in patients with ARDS. Mortality was not significantly greater (41.8 vs 32.2%) in those with ARDS compared to those without (p = 0.27).


CONCLUSIONS
According to the American-European Consensus Conference and the Lung Injury Severity Score definitions, ARDS is common in the adult burn population and has a delayed onset compared to most critical care populations. We found age to be a major predisposing factor for ARDS.
Dancey
D R
DR
Division of Respiratory Medicine, Mt. Sinai Hospital, University of Toronto, Ontario, Canada.
Hayes
J
J
Gomez
M
M
Schouten
D
D
Fish
J
J
Peters
W
W
Slutsky
A S
AS
Stewart
T E
TE
D018806:APACHE; D000328:Adult; D000367:Age Factors; D002059:Burns, Inhalation / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors