title: Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients.
abstract: OBJECTIVE
  First, to determine whether the severity of shock, as measured by systemic hypotension and metabolic acidosis, is significantly associated with a higher risk of acute lung injury in patients with severe trauma. Second, to determine whether the volumes of blood and crystalloid solutions administered in the early posttrauma period are independent risk factors for acute lung injury in severely traumatized patients.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Level I urban trauma center in a university hospital.
  
  
  METHODS
  A total of 102 severely injured, mechanically ventilated trauma patients with an Injury Severity Score > or =16 and aged between 18 and 75 yrs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Initial clinical and laboratory data were collected in the emergency department, and on a daily basis thereafter during the patient's intensive care unit stay. Of the 102 severely injured patients enrolled, 42 developed acute lung injury (41%) and 60 did not (59%). A total of 93% of the trauma patients who developed acute lung injury during the 17-month study period were included in the study. Initial base deficit was significantly lower in patients who developed acute lung injury than in those who did not (-8.8+/-4.5 vs. -5.6+/-5.1, p<.01). The difference in systolic blood pressure between the two groups was not significant.
  
  
  CONCLUSIONS
  In this group of severely injured trauma patients, the degree of metabolic acidosis at the time of admission identified those patients with the highest probability of developing acute lung injury. In addition, the volume of crystalloid solution administered during the first 24 hrs was significantly greater in patients who later developed acute lung injury. Finally, there was a significantly higher morbidity in patients who developed acute lung injury, whereas mortality did not differ between the two groups.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of California, San Francisco, USA.
authors.forename: L W
authors.initials: LW
authors.lastname: Eberhard
authors.forename: D J
authors.initials: DJ
authors.lastname: Morabito
authors.forename: M A
authors.initials: MA
authors.lastname: Matthay
authors.forename: R C
authors.initials: RC
authors.lastname: Mackersie
authors.forename: A R
authors.initials: AR
authors.lastname: Campbell
authors.forename: J D
authors.initials: JD
authors.lastname: Marks
authors.forename: J A
authors.initials: JA
authors.lastname: Alonso
authors.forename: J F
authors.initials: JF
authors.lastname: Pittet
mesh_terms: D018806:APACHE; D000138:Acidosis / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D015601:Injury Severity Score; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D010952:Plasma Substitutes / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012307:Risk Factors; D012774:Shock, Traumatic / Q000150:complications* / Q000473:pathology; D065227:Transfusion Reaction
chemical_list: D010952:Plasma Substitutes