Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy: AAST multicenter post hoc analysis

Martin D. Zielinski, Donald Jenkins, Bryan A. Cotton, Kenji Inaba, Gary Vercruysse, Raul Coimbra, Carlos V R Brown, Darrell E R Alley, Joseph DuBose, Thomas M. Scalea

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78% men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14%). Overall mortality was 23%, with a 39% mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95% confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95% CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95% CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95% CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95% CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.

Original languageEnglish (US)
Pages (from-to)886-891
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number6
DOIs
StatePublished - Dec 11 2014

Keywords

  • Adult respiratory distress syndrome
  • Damage control
  • Laparotomy
  • Open abdomen
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Zielinski, M. D., Jenkins, D., Cotton, B. A., Inaba, K., Vercruysse, G., Coimbra, R., Brown, C. V. R., Alley, D. E. R., DuBose, J., & Scalea, T. M. (2014). Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy: AAST multicenter post hoc analysis. Journal of Trauma and Acute Care Surgery, 77(6), 886-891. https://doi.org/10.1097/TA.0000000000000421