Acute respiratory distress syndrome in the trauma intensive care unit: Morbid but not mortal.
OBJECTIVE
The diagnosis of acute respiratory distress syndrome (ARDS) carries significant additional morbidity and mortality among critically injured patients.


METHODS
Retrospective case-control study using a prospectively maintained ARDS database.


METHODS
Surgical intensive care unit (ICU) in an academic county hospital.


METHODS
All trauma patients admitted to the ICU from January 1, 2000, to December 31, 2003, who developed ARDS as defined by (1) acute onset, (2) a partial pressure of arterial oxygen-fraction of inspired oxygen ratio of 200 or less, (3) bilateral pulmonary infiltrates on chest radiographs, and (4) absence of left-sided heart failure. Each patient with ARDS was matched with 2 control patients without ARDS on the basis of sex, age (+/-5 years), mechanism of injury (blunt or penetrating), Injury Severity Score (+/-3), and chest Abbreviated Injury Score (+/-1).


METHODS
Mortality, hospital charges, hospital and ICU lengths of stay, and complications (defined as pneumonia, deep venous thrombosis, pulmonary embolism, acute renal failure, and disseminated intravascular coagulopathy).


RESULTS
Of 2042 trauma ICU admissions, 216 patients (10.6%) met criteria for ARDS. We identified 432 similarly injured control patients. Compared with controls, trauma patients with ARDS had more complications (43.1% vs 9.5%), longer hospital (32.2 vs 17.9 days) and ICU (22.1 vs 8.4 days) lengths of stay, and higher hospital charges (267,037 dollars vs 136,680 dollars) (P < .01 for all), but mortality was similar (27.8% vs 25.0%, P = .48).


CONCLUSIONS
Although ARDS is associated with increased morbidity, hospital and ICU length of stay, and costs, it does not increase overall mortality among critically ill trauma patients.
Salim
Ali
A
Division of Trauma and Critical Care, Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. asalim@surgery.usc.edu
Martin
Matthew
M
Constantinou
Constantinos
C
Sangthong
Burapat
B
Brown
Carlos
C
Kasotakis
George
G
Demetriades
Demetrios
D
Belzberg
Howard
H
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D017722:Hospital Charges; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data*