• Pedro Navarrete-Navarro, Ricardo Rivera-Fernández, Ma Dolores Rincón-Ferrari, Manuel García-Delgado, Angeles Muñoz, Jose Manuel Jiménez, F J Fernández Ortega, Dolores Ma Mayor García, and GITAN multicenter project.
• Virgen de las Nieves University Hospital, Granada, Spain. pnavarro@ugr.es
• J Crit Care. 2006 Sep 1; 21 (3): 253-8.

PurposeThe aim of the study was to identify early risk factors for development of acute respiratory distress syndrome (ARDS) in severe trauma patients.Materials And MethodsThis was a prospective observational study of 693 severe trauma patients (Injury Severity Score >or=16 and/or Revised Trauma Score ResultsAcute respiratory distress syndrome developed in 6.9% of patients who were more severely ill with higher APACHE II (P < .001) and Injury Severity Score (P = .002) scores vs patients not developing ARDS. Acute respiratory distress syndrome development was associated (P < .001) with fractures of femur (International Classification of Diseases, Ninth Revision [ICD-9] codes 820, 821), tibia (ICD-9 code 823), humerus, and pelvis, with a number (>or=2) of long bone fractures, and with chest injuries (rib/sternal fracture [ICD-9 code 807] and hemo/pneumothorax [ICD-9 code 860/861]). Patients with ARDS required more colloids (P = .005) and red blood cell units (P = .02) than patients without ARDS during the first 24 hours. Multivariate analysis showed that ARDS was related to chest trauma diagnosis (ICD-9 code 807) (odds ratio [OR], 3.85), femoral fracture (OR, 3.16), APACHE II score (OR, 1.05), and blood transfusion during resuscitation (OR, 1.32).ConclusionsRisk of ARDS development is related to the first 24-hour admission variables, including severe physiologic derangements and specific ICD-9-classified injuries. Blood transfusion may play an independent role.

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