Respiratory failure & ventilation
Acute Respiratory Distress Syndrome in Trauma 2007–2019: Comprehensive Patient and Center-Level Retrospective Cohort Analysis
Main finding · 30-day hospital mortalityResult — go to the resultOdds ratio 1.32 95% CI 1.27–1.37Authors' conclusion
From 2007 to 2019, ARDS decreased significantly in trauma patients. Over the same time, mortality increased to nearly 30%, and after adjusting for other risks factors, ARDS was strongly associated with 30-day mortality.
Study context
- Population
- Injured adults (≥18 y) on mechanical ventilation ≥2 days, American College of Surgeons National Trauma Data Bank, 2007–2019on mechanical ventilation (MV)
- Participants
- 384,032 adults
- Exposure
- Acute respiratory distress syndrome (ARDS) vs no ARDS
- ARDSn = 29,359
- Outcome
- 30-day hospital mortality
- Follow-up
- 30 days
Methodological detailsmultivariable logistic regression, national registry
- Multivariable logistic regression
- National registry
Main finding
As reported in the abstract
Odds ratio
1.32
95% CI 1.27–1.37
Observational data: associations, not effects.
Further findings
Patient-level risk factors independently associated with ARDS
| OR (95% CI) | ||
|---|---|---|
| Blunt injury | 1.25 (1.20–1.30) | |
| Severe sepsis | 2.16 (2.06–2.27) | |
| VAP | 2.91 (2.82–3.00) | |
| AKI | 2.98 (2.85–3.12) | |
| 0.20.5125Odds ratio (log scale) |
Blood products associated with ARDS (transfusion subset) · 24 hours
| OR (95% CI) | ||
|---|---|---|
| 24-hour plasma | 1.02 (1.01–1.04) | |
| Platelets | 1.03 (1.02–1.05) | |
| 0.512Odds ratio (log scale) |
Independent risk factors for 30-day mortality in patients with ARDS
| OR (95% CI) | ||
|---|---|---|
| Head injury | 1.54 (1.43–1.66) | |
| Severe sepsis | 1.48 (1.34–1.63) | |
| AKI | 2.72 (2.50–2.96) | |
| 0.20.5125Odds ratio (log scale) |
Death in patients with ARDS by center type
| OR (95% CI) | ||
|---|---|---|
| Prevention and Early Treatment of Acute Lung Injury and Extracorporeal Life Support Organization centersLess likely to die | 0.78 (0.72–0.84) | |
| 0.512Odds ratio (log scale) |
ARDS frequency (per 100 MV patients) · 2007 vs 2019
- ARDS per 100 MV patients in 2007
- 22
- ARDS per 100 MV patients in 2019
- 3
- ARDS documented in 29,359 of 384,032 MV patients (8 per 100 MV patients)
- Significant decrease over the study period, p < 0.001
Crude ARDS mortality · 2007 vs 2019
- Crude ARDS mortality 2007
- 15.1%
- Crude ARDS mortality 2019
- 29.7%
- Increased over the study period, p < 0.001
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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