Acute Respiratory Distress Syndrome in Trauma 2007-2019: Comprehensive Patient and Center-Level Retrospective Cohort...

Area of Science:

• Trauma critical care
• Pulmonary medicine
• Epidemiology of critical illness

Background:

• Acute respiratory distress syndrome (ARDS) is a severe complication in trauma patients, yet its epidemiology and impact on mortality are not fully understood.
• Understanding trends and risk factors for ARDS in trauma is crucial for improving patient outcomes.

Purpose of the Study:

• To define trends in ARDS frequency among trauma patients.
• To identify patient and center-level factors associated with ARDS development and mortality.
• To determine if ARDS independently predicts 30-day mortality in trauma patients.

Main Methods:

• Retrospective cohort study using data from the American College of Surgeons National Trauma Data Bank (2007-2019).
• Included injured patients aged 18+ on mechanical ventilation (MV) for ≥2 days.
• Multivariable logistic regression adjusted for demographics, center characteristics, and blood products.

Main Results:

• ARDS incidence decreased from 22 to 3 per 100 MV patients (2007-2019).
• Risk factors for ARDS included blunt injury, severe sepsis, ventilator-associated pneumonia, and acute kidney injury (AKI).
• Crude ARDS mortality increased from 15.1% to 29.7% (2007-2019); ARDS independently predicted 30-day mortality (OR 1.32).

Conclusions:

• Despite a decrease in ARDS incidence, mortality among trauma patients with ARDS significantly increased.
• ARDS remains a strong independent predictor of 30-day mortality in trauma.
• Further research into modifiable patient and center-level factors is needed to reduce mortality in high-risk trauma patients.