Risk Factors for the Development of Acute Respiratory Distress Syndrome Following Hemorrhage

Area of Science:

• Trauma resuscitation
• Hemorrhagic shock management
• Acute Respiratory Distress Syndrome (ARDS) pathophysiology

Background:

• The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study investigated hemostasis and mortality in hemorrhage.
• Pulmonary consequences of whole blood-mimicking resuscitation strategies remain unclear.

Purpose of the Study:

• To analyze pulmonary outcomes from a secondary analysis of the PROPPR trial.
• To determine the impact of different plasma-platelet-red blood cell ratios on ARDS development.

Main Methods:

• Secondary analysis of PROPPR study data involving trauma patients randomized to 1:1:1 or 1:1:2 plasma-platelet-RBC ratios.
• Included patients with survival >24 hours, ICU stay, and recorded PaO2/FiO2 (P/F) ratio.
• ARDS defined as P/F ratio <200 with bilateral infiltrates, adjudicated by investigators.

Main Results:

• No significant differences in ARDS rates (14.8% vs. 18.4%), ventilator/ICU-free days, length of stay, or 30-day mortality between resuscitation groups.
• ARDS associated with blunt injury and higher chest Abbreviated Injury Scale (AIS) scores.
• Each 500mL crystalloid in the first 6 hours increased ARDS risk (OR 1.09).

Conclusions:

• Acute crystalloid administration is a modifiable risk factor for ARDS post-hemorrhage.
• Blood products did not emerge as a risk factor for lung injury in this cohort.
• Limiting crystalloid infusion may be a strategy to prevent ARDS in trauma patients.