• Carolyn M Hendrickson, Benjamin M Howard, Lucy Z Kornblith, Amanda S Conroy, Mary F Nelson, Hanjing Zhuo, Kathleen D Liu, Geoffrey T Manley, Michael A Matthay, Carolyn S Calfee, and Mitchell J Cohen.
• From the Division of Pulmonary and Critical Care Medicine (C.M.H., H.Z., C.S.C, M.A.M.) and Division of Nephrology and Critical Care Medicine (K.D.L.), Departments of Medicine and Anesthesia, University of California San Francisco; and Department of Surgery (B.M.H., L.Z.K., A.S.C., M.F.N., M.J.C.) and Department of Neurological Surgery (G.T.M.), University of California San Francisco and San Francisco General Hospital; San Francisco, California.
• J Trauma Acute Care Surg. 2016 Jun 1; 80 (6): 989-97.

BackgroundAcute 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.MethodsWe 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 a head Abbreviated Injury Scale (AIS) score of 3 or greater and AIS score lower than 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.ResultsThe incidence of ARDS in the first 8 days after severe isolated TBI was 30%. Patients who developed ARDS were administered more crystalloids (4.3 L 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 intensive care unit and hospital stays (4 days vs. 13 days, p < 0.001, and 7.5 days vs. 14.5 days, p < 0.001, respectively). In unadjusted logistic regression analyses, the odds of developing ARDS were significantly associated with head AIS score (odds ratio [OR], 1.8; p = 0.018), male sex (OR, 2.9; p = 0.012), and early transfusion of platelets (OR, 2.8; p = 0.003). These associations were similar in a multivariate logistic regression model.ConclusionIn 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 EvidencePrognostic/epidemiologic study, level III.

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