• J C Schramm, D Neveling, and G Muhr.
• Chirurgische Universitätsklinik, Berufsgenossenschaftliche Krankenanstalten, Bergmannsheil, Bochum.
• Unfallchirurg. 1990 Dec 1; 93 (12): 573-7.

AbstractThe data recorded in 10 multitrauma patients who died of respiratory insufficiency (ARDS) were retrospectively compared with corresponding data recorded in 10 patients with similar injury scores who survived. All 20 patients had had respirator therapy from the 1st day onward. The criteria for ARDS were: (1) death in respiratory insufficiency after trauma. (2) chest X-rays showing signs of ARDS, (3) continuous decrease in the Horowitz quotient, and (4) autopsy (50% of the patients). The goal was to find out which variables give the first indication that ARDS is developing. Leukocyte and serum fibrinogen levels proved to have no discriminatory value. The inspiratory oxygen concentration needed (FiO2) and the Horowitz quotient differed in a highly significant manner beginning on the 1st day after trauma. None of the survivors needed an FiO2 of over 0.28 by the 2nd posttraumatic day, while none of the ARDS patients needed less than 0.35. In survivors the Horowitz quotient increased up to physiological values on the 2nd day. A significantly higher PEEP from the 3rd posttraumatic day onward was needed in ARDS patients. The respiratory peak-pressure increased significantly from the 2nd posttraumatic day.

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