Early application of airway pressure release ventilation may reduce mortality in high-risk trauma patients: a systematic review of observational trauma ARDS literature.
BACKGROUND
Adult respiratory distress syndrome is often refractory to treatment and develops after entering the health care system. This suggests an opportunity to prevent this syndrome before it develops. The objective of this study was to demonstrate that early application of airway pressure release ventilation in high-risk trauma patients reduces hospital mortality as compared with similarly injured patients on conventional ventilation.


METHODS
Systematic review of observational data in patients who received conventional ventilation in other trauma centers were compared with patients treated with early airway pressure release ventilation in our trauma center. Relevant studies were identified in a PubMed and MEDLINE search from 1995 to 2012 and included prospective and retrospective observational and cohort studies enrolling 100 or more adult trauma patients with reported adult respiratory distress syndrome incidence and mortality data.


RESULTS
Early airway pressure release ventilation as compared with the other trauma centers represented lower mean adult respiratory distress syndrome incidence (14.0% vs. 1.3%) and in-hospital mortality (14.1% vs. 3.9%).


CONCLUSIONS
These data suggest that early airway pressure release ventilation may prevent progression of acute lung injury in high-risk trauma patients, reducing trauma-related adult respiratory distress syndrome mortality.


METHODS
Systematic review, level IV.
From the R Adams Cowley Shock Trauma Center (P.L.A., T.S., N.M.H.); and Department of Orthopaedics (R.V.O.), University of Maryland School of Medicine, Baltimore Maryland; University of Florida College of Medicine (J.R.S.), Jacksonville; and Orlando Health MERTC (E.J.-K.), Orlando, Florida; Upstate Medical University (S.R., B.S., G.F.N.), Syracuse; and SUNY Cortland (L.A.G.), Cortland, New York.
Penny L
PL
Andrews
Joseph R
JR
Shiber
Ewa
E
Jaruga-Killeen
Shreyas
S
Roy
Benjamin
B
Sadowitz
Robert V
RV
O'Toole
Louis A
LA
Gatto
Gary F
GF
Nieman
Thomas
T
Scalea
Nader M
NM
Habashi
D000328:Adult; D045422:Continuous Positive Airway Pressure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*