Medical planning for disaster response: Identifying risk factors for developing adult respiratory distress syndrome among trauma patients
Keywords:ARDS, trauma, humanitarian response, diabetes, smoking
Introduction: Adult respiratory distress syndrome (ARDS) is a well-described complication of critical illness. We hypothesized that rates of comorbid diseases in a population may influence the risk for developing ARDS in trauma patients. This can help plan medical responses.
Methods: Patients from the 2017 National Trauma Databank were analyzed. Inclusion criteria were an injury severity score (ISS) of ≥ 2 and 1 or more documented days of mechanical ventilation. Data were analyzed using χ2, Student’s t test, Mann–Whitney U test, or logistic regression as indicated.
Results: Diabetes (odds ratio [OR] 1.33, 95 percent confidence interval [CI] 1.17-1.52), smoking (OR 1.26, 95 percent CI 1.13-1.40), transfusion (OR 1.20, 95 percent CI 1.09-1.32), ISS (OR 1.02, 95 percent CI 1.02-1.03), male gender (OR 1.22, 95 percent CI 1.10-1.35), decreasing Glasgow coma score (OR 1.04, 95 percent CI 1.03-1.05), and increasing abbreviated injury score of the thorax (OR 1.12, 95 percent CI 1.09-1.16) were associated with an increase in risk for developing ARDS.
Conclusion: Diabetes and smoking are risk factors for developing ARDS after trauma. Medical response planning in countries with high rates of diabetes mellitus or smoking should take into account a greater need for intensive care and longer patient admissions to field hospitals.
Robles A, Kornblith L, Hendrickson C, et al.: Health care utilization and the cost of posttraumatic acute respiratory distress syndrome care. J Trauma Acute Care Surg. 2018; 85(1): 148-154.
Keneally R, Szpisjak D: Thoracic trauma in Iraq and Afghanistan. J Trauma Acute Care Surg. 2013; 74(5): 1292-1297.
Keneally RJ, Shields CH, Hsu A, et al.: Pediatric thoracic trauma in Iraq and Afghanistan. Mil Med. 2018; 183(11-12): e596-e602.
Chan M, Shorr A, Perkins J: Factors associated with acute lung injury in combat casualties receiving massive blood transfusions: A retrospective analysis. J Crit Care. 2012; 27(4): 417-414.
Spinella P, Perkins J, Grathwohl K, et al.: Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009; 66(4): S69-S76.
Belenkiy S, Buel A, Cannon J, et al.: Acute respiratory distress syndrome in wartime military burns: Application of the Berlin criteria. J Trauma Acute Care Surg. 2014; 76(3): 821–827.
NTDB 2017 Data Dictionary. Available at https://www.facs.org/-/media/files/quality-programs/trauma/ntdb/ntds/data-dictionaries/ntdsdatadictionary2017admissions.ashx. Accessed December 17, 2019.
Calfee CS, Eisner MD, Ware LB, et al.: Trauma-associated lung injury differs clinically and biologically from acute lung injury due to other clinical disorders. Crit Care Med. 2007; 35(10): 2243-2250.
Robinson BRH, Cohen MJ, Holcomb JB, et al.: Risk factors for the development of acute respiratory distress syndrome following hemorrhage. Shock. 2018; 50(3): 258-264.
Hofman M, Andruszkow H, Kobbe P, et al.: Incidence of posttraumatic pneumonia in poly-traumatized patients: Identifying the role of traumatic brain injury and chest trauma. Eur J Trauma Emerg Surg. 2020; 46(1): 11-19.
Tignanelli CJ, Hemmila MR, Rogers MAM, et al.: Nationwide cohort study of independent risk factors for acute respiratory distress syndrome after trauma. Trauma Surg Acute Care Open. 2019; 4(1): e000249.
Ji M, Chen M, Hong X, et al.: The effect of diabetes on the risk and mortality of acute lung injury/acute respiratory distress syndrome: A meta-analysis. Medicine (Baltimore). 2019; 98(13): e15095.
Boyle AJ, Madotto F, Laffey JG, et al.: Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: An analysis of the LUNG SAFE database. Crit Care. 2018; 22(1): 268.
Bellani G, Laffey JG, Pham T, et al.: Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016; 315(8): 788-800.
Tracy BM, Wilson JM, Staley C, et al.: Metabolic syndrome: Major risk factor for morbidity and mortality in severely injured trauma patients. J Am Coll Surg. 2020; 230(1): 145-150.
Li X, Yu J, Huang W, et al.: Risk factors analysis of acute respiratory distress syndrome in intensive care unit traumatic patients. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018; 30(10): 978-982.
International Diabetes Federation: IDF Diabetes Atlas, 9th ed. Brussels, Belgium: International Diabetes Federation, 2019. Available at https://www.diabetesatlas.org. Accessed October 8, 2020.
Calfee CS, Matthay MA, Eisner MD, et al.: Active and passive cigarette smoking and acute lung injury after severe blunt trauma. Am J Respir Crit Care Med. 2011; 183(12): 1660-1665.
Moazed F, Hendrickson C, Nelson M, et al.: Platelet aggregation after blunt trauma is associated with the acute respiratory distress syndrome and altered by cigarette smoke exposure. J Trauma Acute Care Surg. 2018; 84(2): 365-371.
Ng M, Freeman MK, Fleming TD, et al.: Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA. 2014; 311(2): 183-192.
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved