The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition
The Acute Respiratory Distress Syndrome (ARDS) in mechanically ventilated burn patients: An analysis of risk factors, clinical features, and outcomes using the Berlin ARDS definition
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DOI：
10.1016/j.burns.2016.01.031
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发表时间：
2016-11-01
期刊：
影响因子：
2.7
通讯作者：
Camacho, Fernando
中科院分区：
文献类型：
--
作者：
Cartotto, Robert;Li, Zeyu;Camacho, Fernando
背景资料：柏林定义的急性呼吸窘迫综合征（ARDS）已应用于军事烧伤所致的战斗创伤，但尚未在民用烧伤中广泛研究。本研究的目的是使用柏林的定义，以确定ARDS的发病率，其相关的呼吸系统的发病率和死亡率平民burnpatients.Methods：回顾性研究烧伤患者机械通气>= 48小时，在美国烧伤协会验证烧伤中心。柏林标准确定了轻度、中度和重度ARDS患者。Logistic回归分析用于确定预测中度至重度ARDS和死亡率的变量。关注的结局指标为机械通气持续时间和住院死亡率。结果：我们包括162名受试者[24%女性，年龄48（35-60），%全身表面积（TBSA）烧伤28（19-40），%体表面积（BSA）全层（FT）烧伤13（0-30），62%伴有吸入性损伤]。ARDS发生率为43%。ARDS患者有较大的%TBSA烧伤[30.5（23.1-47.0）与24.8（17.1-35），p = 0.007]，较大FT烧伤[20.5（5.4-35.5）vs. 7（0-22.1），p = 0.001]，但与无ARDS的患者相比，吸入性损伤的发生率无显著差异（p = 0.216）。% FT烧伤预测中度至重度ARDS的发展[OR 1.034，95%CI（1.013-1.055），p = 0.001]。86%的病例在伤后1周内发生ARDS。ARDS严重程度恶化与存活者机械通气天数增加（p = 0.001）、所有受试者前30天无呼吸机天数减少（p = 0.004）以及死亡率增加（轻度ARDS为0%，重度ARDS为50%，未校正p = 0.02）相关。结论：机械通气平民烧伤患者中，ARDS是常见的，并在烧伤后早期发展。全层烧伤的程度预示着中度至重度ARDS的发展。根据柏林定义，ARDS严重程度的增加与机械通气持续时间的显著延长和死亡率的增加相关。(C)2016 Elsevier Ltd和ISBI。All rights reserved.
Background: The Berlin definition of Acute Respiratory Distress Syndrome (ARDS) has been applied to military burns resulting from combat-related trauma, but has not been widely studied among civilian bums. This study's purpose was to use the Berlin definition to determine the incidence of ARDS, and its associated respiratory morbidity, and mortality among civilian burn patients.Methods: Retrospective study of burn patients mechanically ventilated for >= 48 h at an American Bum Association-verified bum center. The Berlin criteria identified patients with mild, moderate, and severe ARDS. Logistic regression was used to identify variables predictive of moderate to severe ARDS, and mortality. The outcome measures of interest were duration of mechanical ventilation and in-hospital mortality. Values are shown as the median (Q1-Q3).Results: We included 162 subjects [24% female, age 48 (35-60), % total body surface area (TBSA) burn 28 (19-40), % body surface area (BSA) full thickness (FT) burn 13 (0-30), and 62% with inhalation injury]. The incidence of ARDS was 43%. Patients with ARDS had larger %TBSA burns [30.5 (23.1-47.0) vs. 24.8 (17.1-35), p = 0.007], larger FT burns [20.5(5.4-35.5) vs. 7 (0-22.1), p = 0.001], but had no significant difference in the incidence of inhalation injury (p = 0.216), compared to those without ARDS. The % FT burn predicted the development of moderate to severe ARDS [OR 1.034, 95%CI (1.013-1.055), p = 0.001]. ARDS developed in the 1st week after burn in 86% of cases. Worsening severity of ARDS was associated with increased days of mechanical ventilation in survivors (p = 0.001), a reduction in ventilator free days/1st 30 days in all subjects (p = 0.004), and a strong indication of increased mortality (0% in mild ARDS vs. 50% in severe ARDS, unadjusted p = 0.02). Neither moderate ARDS nor severe ARDS were significant predictors of death.Conclusions: ARDS is common among mechanically ventilated civilian bum patients, and develops early after bum. The extent of full thickness burn predicted development of moderate to severe ARDS. Increasing severity of ARDS based upon the Berlin definition was associated with a significantly greater duration of mechanical ventilation and a trend toward higher mortality. (C) 2016 Elsevier Ltd and ISBI. All rights reserved.