Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy

AAST multicenter post hoc analysis

Martin D. Zielinski, Donald Jenkins, Bryan A. Cotton, Kenji Inaba, Gary Vercruysse, Raul Coimbra, Carlos V.R. Brown, Darrell E.R. Alley, Joseph DuBose, Thomas M. Scalea, B. Shrestha, J. Holcomb, K. Inaba, O. Okoye, A. Konstantinidis, T. Scalea, J. Menaker, J. DuBose, J. F. Whelan, R. Ivatury & 27 others S. R. Goldberg, M. D. Zielinski, D. Jenkins, K. V. Ballman, W. S. Harmsen, S. Rowe, D. Alley, J. Berne, L. Allen, PG Pieri, S. Haney, J. A. Claridge, K. Kelly, T. Bee, Timothy Fabian, R. Coimbra, J. Doucet, B. Coopwood, D. Keith, C. Brown, J. M. Haan, J. Ward, S. M. Leon, E. Eriksson, D. Couillard, M. A. de Moya, G. M. van der Wilden

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78% men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14%). Overall mortality was 23%, with a 39% mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95% confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95% CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95% CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95% CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95% CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.

Original languageEnglish (US)
Pages (from-to)886-891
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number6
DOIs
StatePublished - Dec 11 2014

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Adult Respiratory Distress Syndrome
Laparotomy
Confidence Intervals
Injury Severity Score
Water-Electrolyte Balance
Mortality
Trauma Centers
Wounds and Injuries
Colloids
Abdomen
Hospitalization
Regression Analysis
Databases
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy : AAST multicenter post hoc analysis. / Zielinski, Martin D.; Jenkins, Donald; Cotton, Bryan A.; Inaba, Kenji; Vercruysse, Gary; Coimbra, Raul; Brown, Carlos V.R.; Alley, Darrell E.R.; DuBose, Joseph; Scalea, Thomas M.; Shrestha, B.; Holcomb, J.; Inaba, K.; Okoye, O.; Konstantinidis, A.; Scalea, T.; Menaker, J.; DuBose, J.; Whelan, J. F.; Ivatury, R.; Goldberg, S. R.; Zielinski, M. D.; Jenkins, D.; Ballman, K. V.; Harmsen, W. S.; Rowe, S.; Alley, D.; Berne, J.; Allen, L.; Pieri, PG; Haney, S.; Claridge, J. A.; Kelly, K.; Bee, T.; Fabian, Timothy; Coimbra, R.; Doucet, J.; Coopwood, B.; Keith, D.; Brown, C.; Haan, J. M.; Ward, J.; Leon, S. M.; Eriksson, E.; Couillard, D.; de Moya, M. A.; van der Wilden, G. M.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 6, 11.12.2014, p. 886-891.

Research output: Contribution to journalArticle

Zielinski, MD, Jenkins, D, Cotton, BA, Inaba, K, Vercruysse, G, Coimbra, R, Brown, CVR, Alley, DER, DuBose, J, Scalea, TM, Shrestha, B, Holcomb, J, Inaba, K, Okoye, O, Konstantinidis, A, Scalea, T, Menaker, J, DuBose, J, Whelan, JF, Ivatury, R, Goldberg, SR, Zielinski, MD, Jenkins, D, Ballman, KV, Harmsen, WS, Rowe, S, Alley, D, Berne, J, Allen, L, Pieri, PG, Haney, S, Claridge, JA, Kelly, K, Bee, T, Fabian, T, Coimbra, R, Doucet, J, Coopwood, B, Keith, D, Brown, C, Haan, JM, Ward, J, Leon, SM, Eriksson, E, Couillard, D, de Moya, MA & van der Wilden, GM 2014, 'Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy: AAST multicenter post hoc analysis', Journal of Trauma and Acute Care Surgery, vol. 77, no. 6, pp. 886-891. https://doi.org/10.1097/TA.0000000000000421
Zielinski, Martin D. ; Jenkins, Donald ; Cotton, Bryan A. ; Inaba, Kenji ; Vercruysse, Gary ; Coimbra, Raul ; Brown, Carlos V.R. ; Alley, Darrell E.R. ; DuBose, Joseph ; Scalea, Thomas M. ; Shrestha, B. ; Holcomb, J. ; Inaba, K. ; Okoye, O. ; Konstantinidis, A. ; Scalea, T. ; Menaker, J. ; DuBose, J. ; Whelan, J. F. ; Ivatury, R. ; Goldberg, S. R. ; Zielinski, M. D. ; Jenkins, D. ; Ballman, K. V. ; Harmsen, W. S. ; Rowe, S. ; Alley, D. ; Berne, J. ; Allen, L. ; Pieri, PG ; Haney, S. ; Claridge, J. A. ; Kelly, K. ; Bee, T. ; Fabian, Timothy ; Coimbra, R. ; Doucet, J. ; Coopwood, B. ; Keith, D. ; Brown, C. ; Haan, J. M. ; Ward, J. ; Leon, S. M. ; Eriksson, E. ; Couillard, D. ; de Moya, M. A. ; van der Wilden, G. M. / Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy : AAST multicenter post hoc analysis. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 6. pp. 886-891.
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title = "Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy: AAST multicenter post hoc analysis",
abstract = "Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78{\%} men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14{\%}). Overall mortality was 23{\%}, with a 39{\%} mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95{\%} confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95{\%} CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95{\%} CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95{\%} CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95{\%} CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.",
author = "Zielinski, {Martin D.} and Donald Jenkins and Cotton, {Bryan A.} and Kenji Inaba and Gary Vercruysse and Raul Coimbra and Brown, {Carlos V.R.} and Alley, {Darrell E.R.} and Joseph DuBose and Scalea, {Thomas M.} and B. Shrestha and J. Holcomb and K. Inaba and O. Okoye and A. Konstantinidis and T. Scalea and J. Menaker and J. DuBose and Whelan, {J. F.} and R. Ivatury and Goldberg, {S. R.} and Zielinski, {M. D.} and D. Jenkins and Ballman, {K. V.} and Harmsen, {W. S.} and S. Rowe and D. Alley and J. Berne and L. Allen and PG Pieri and S. Haney and Claridge, {J. A.} and K. Kelly and T. Bee and Timothy Fabian and R. Coimbra and J. Doucet and B. Coopwood and D. Keith and C. Brown and Haan, {J. M.} and J. Ward and Leon, {S. M.} and E. Eriksson and D. Couillard and {de Moya}, {M. A.} and {van der Wilden}, {G. M.}",
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language = "English (US)",
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TY - JOUR

T1 - Adult respiratory distress syndrome risk factors for injured patients undergoing damage-control laparotomy

T2 - AAST multicenter post hoc analysis

AU - Zielinski, Martin D.

AU - Jenkins, Donald

AU - Cotton, Bryan A.

AU - Inaba, Kenji

AU - Vercruysse, Gary

AU - Coimbra, Raul

AU - Brown, Carlos V.R.

AU - Alley, Darrell E.R.

AU - DuBose, Joseph

AU - Scalea, Thomas M.

AU - Shrestha, B.

AU - Holcomb, J.

AU - Inaba, K.

AU - Okoye, O.

AU - Konstantinidis, A.

AU - Scalea, T.

AU - Menaker, J.

AU - DuBose, J.

AU - Whelan, J. F.

AU - Ivatury, R.

AU - Goldberg, S. R.

AU - Zielinski, M. D.

AU - Jenkins, D.

AU - Ballman, K. V.

AU - Harmsen, W. S.

AU - Rowe, S.

AU - Alley, D.

AU - Berne, J.

AU - Allen, L.

AU - Pieri, PG

AU - Haney, S.

AU - Claridge, J. A.

AU - Kelly, K.

AU - Bee, T.

AU - Fabian, Timothy

AU - Coimbra, R.

AU - Doucet, J.

AU - Coopwood, B.

AU - Keith, D.

AU - Brown, C.

AU - Haan, J. M.

AU - Ward, J.

AU - Leon, S. M.

AU - Eriksson, E.

AU - Couillard, D.

AU - de Moya, M. A.

AU - van der Wilden, G. M.

PY - 2014/12/11

Y1 - 2014/12/11

N2 - Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78% men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14%). Overall mortality was 23%, with a 39% mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95% confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95% CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95% CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95% CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95% CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.

AB - Background: Severely injured patients undergoing damage-control laparotomy (DCL) have multiple risk factors for adult respiratory distress syndrome (ARDS), making it challenging to differentiate the contributions of individual causative factors. We aimed to determine the relative contributions of ARDS risk factors. Methods: Analysis of the prospectively collected American Association for the Surgery of Trauma Multi-institutional Open Abdomen Database was performed. Inclusion criteriawere any patient, 18 years or older, undergoing DCL at 1 of 14 participating Level I trauma centers. Univariable and multivariable Cox regression analyses were performed to determine the association of variables with the development of ARDS during hospitalization. Results: A total of 563 patients (78% men; mean [SD] age, 40 [18] years) were identified, of whom 77 developed ARDS (14%). Overall mortality was 23%, with a 39% mortality rate for ARDS patients. Univariable analysis demonstrated that Injury Severity Score (ISS, 1.03; 95% confidence interval [CI], 1.02-1.05), intraoperative (IO) estimated blood loss (hazard ratio [HR], 1.09; 95% CI, 1.04-1.13), IO plasma transfusion (HR, 1.17; 95% CI, 1.10-1.25), 24-hour colloid volume (HR, 1.07; 95% CI, 1.04-1.10), and 24-hour crYstalloid volume (HR, 1.01; 95% CI, 1.00Y1.01) were associated with the development of ARDS. Cox multivariable analYsis demonstrated that ISS, IO plasma transfusions, and total fluid balance through 23 hours all increased the risk of ARDS development. Conclusion: SeveritY of injurY, plasma transfusions, and greater fluid administration bY 24 hourswere independentlY associated with ARDS development. Judicious use of plasma and other fluids maY reduce rates of ARDSin this criticallY injured population.

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DO - 10.1097/TA.0000000000000421

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