Citation

Hendrickson CM, Howard BM, Kornblith LZ, Conroy AS, Nelson MF, Zhuo H, Liu KD, Manley G, Matthay MA, Calfee CS, Cohen MJ. J. Trauma Acute Care Surg. 2016; 80(6): 989-997.

Copyright

(Copyright © 2016, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000000982

PMID

unavailable

Abstract

BACKGROUND: Acute respiratory distress syndrome (ARDS) is common after Traumatic Brain Injury (TBI) and is associated with worse neurologic outcomes and longer hospitalization. However, the incidence and associated causes of ARDS in isolated TBI have not been well studied.

METHODS: We performed a subgroup analysis of 210 consecutive patients with isolated severe TBI enrolled in a prospective observational cohort at a Level 1 Trauma Center between 2005 and 2014. Subjects required endotracheal intubation and had isolated severe TBI defined by an Abbreviated Injury Score (AIS) Head >=3 and AIS <3 in all other categories. ARDS within the first 8 days of admission was rigorously adjudicated using Berlin Criteria. Regression analyses were used to test the association between predictors of interest and ARDS.

RESULTS: The incidence of ARDS in the first eight days after severe isolated TBI was 30%. Patients who developed ARDS were administered more crystalloids (4.3 vs. 3.5 L, p= 0.005) and blood products in the first 12 hours of admission. Patients with ARDS had significantly worse clinical outcomes measured at 28 days, including longer median lengths of ICU and hospital stays (4 vs. 13 days, p<0.001, and 7.5 vs. 14.5 days, p<0.001, respectively). In unadjusted logistic regression analyses, the odds of developing ARDS were significantly associated with AIS Head score (OR 1.8, p=0.018), male sex (OR 2.9, p=0.012), and early transfusion of platelets 2.8 (p=0.003). These associations were similar in a multivariate logistic regression model.

CONCLUSIONS: In the era of balanced hemostatic resuscitation practices, severity of head injury, male sex, early crystalloids and early transfusion of platelets are associated with a higher risk of ARDS after severe isolated TBI. Early transfusion of platelets after severe TBI may be a modifiable risk factor for ARDS, and these findings invite further investigation into causal mechanisms driving this observed association.

LEVEL OF EVIDENCE: Level III; Epidemiologic

(C) 2016 Lippincott Williams & Wilkins, Inc.

Language: en