Early post-traumatic acute respiratory distress syndrome and albumin excretion rate: a prospective evaluation of a 'point-of care' predictive test.
All patients sustaining major trauma exhibit increased capillary permeability, manifested as micro-albuminuria. Urinary albumin excretion rate (AER) measured on intensive care units (ICU) can predict early post-traumatic acute respiratory distress syndrome (ARDS). This prospective study sought to evaluate AER as a practical predictive test for early ARDS. Staff at the participating centres were trained in the use of the Behring Turbitimer and the concept of AER as a predictor of early post-traumatic ARDS. AER was measured every 2 h for the first 24 h, on 54 adult blunt trauma admissions (ISS>/=18). A diagnosis of early acute lung injury (ALI) or ARDS was made using the American-European Consensus Conference criteria. Eleven patients developed ARDS, ten developed ALI, and 23 had no pulmonary dysfunction. The AER was significantly greater in those who developed ARDS 8 and 18 h after admission. The positive predictive value of the test was 64% at 8 h, the negative predictive power 73%. The test was performed most consistently in the middle 10 h of the study period. If intervention had been based on the 8 h data point result, 75% patients who had the test performed and later developed ARDS would have had intervention appropriately. In principle, testing for AER as a predictor of post-traumatic ARDS on ICU is feasible, however, this study has underlined the challenges of introducing new concepts into the ICU environment.
Pallister
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University of Wales College of Medicine, Heath Park, CF14 4XN, Cardiff, UK. ianpallister@hotmail.com
Dent
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Wise
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Alpar
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Gosling
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D000419:Albuminuria / Q000209:etiology*; D003625:Data Collection; D006801:Humans; D019095:Point-of-Care Systems / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000652:urine; D012680:Sensitivity and Specificity; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*