Acute respiratory distress syndrome in the trauma intensive care unit: the other view

To study the timeliness of the diagnosis of patients with acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) at the Puerto Rico Trauma Center (PRTC) and to determine the overall 28 day mortality for ARDS during the study period.

A retrospective review of all admissions to the Trauma Intensive Care Unit (TICU) from August 2000 to August 2001 was done. Patients with the diagnosis of ARDS/ALI were selected, records examined, and clinical data obtained for analysis.

Of the 537 patient admitted to the PRTC, 236 patient were admitted to TICU. Of these, 17 patients were identified as having hypoxemic ratios below 200 and 13 patients were identified as having ARDS as established by the American-European Consensus Conference of 1994. Their mean age was 41 years, the main cause of ARDS was due to pulmonary contusion due to blunt chest trauma. The 28-day survival for this group was 43%. Subgroup analysis showed that there was 86% mortality when the polytraumatized patient developed sepsis.

The majority of the cases of ARDS were correctly identified as such by caregivers at the time of diagnosis. Mortality as predicted by Injury Severity Score in our ARDS patients' correlates with overall mortality in our TICU. Mortality in this group is lower than that of reported literature, in sharp contrast to our medical ICU counterparts.