Predictors of Early Acute Lung Injury at a Combat Support Hospital: A Prospective Observational Study
Predictors of Early Acute Lung Injury at a Combat Support Hospital: A Prospective Observational Study
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DOI：
10.1097/ta.0b013e3181e44a32
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发表时间：
2010-07-01
影响因子：
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通讯作者：
Blackbourne, Lorne H.
中科院分区：
文献类型：
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作者：
Edens, Jason W.;Chung, Kevin K.;Blackbourne, Lorne H.
背景资料：急性肺损伤（acute lung injury，ALI）是一种由非心源性急性低氧性呼吸衰竭伴双侧肺浸润组成的综合征，发生于33%的危重创伤患者。回顾性和观察性研究表明，使用等比例的浓缩红细胞（PRBC）和新鲜冷冻血浆（FFP）的血液成分复苏策略可能对战斗伤员的生存有益。本研究的目的是确定这种策略是否与ALI发病率的增加有关。方法：我们对一家战斗支援医院的重症监护室（ICU）收治的所有受伤患者进行了前瞻性观察研究，这些患者在入院后24小时内需要> 5个单位的输血。收集基线人口统计学数据以及损伤严重程度评分（ISS）、肺损伤、长骨骨折、输血、机械通气数据和动脉血气分析。该研究的主要终点是损伤后48小时的ALI发展。未存活至ICU入院的患者被排除在分析之外。由于快速转出我们的机构，无法获得超过48小时的随访（包括死亡率）。进行多变量logistic回归，以确定变量对早期ALI.Results发病率的独立影响：在12个月期间（2008年1月至2008年12月），87名受试者进行了研究，其中，66例患者符合纳入标准，22例患者在48小时（33%）发生ALI。总体而言，新鲜粮食产品与持久性有机污染物的比例为1：1.1。那些发展成ALI的人有更高的ISS（32 +/-15 vs. 26 +/-11; p = 0.04）并接受更多单位的FFP（22 +/-15 vs. 12 +/-7; p <0.001）、PRBC（22 +/-16 vs. 13 +/-7; p = 0.008）和血小板（5 +/-11 vs. 1 +/-2; p = 0.004）。多因素Logistic回归分析显示，肺损伤的存在（比值比，5.4; 95%置信区间，1.3 - 21.9）和FFP输注量（比值比，1.2; 95%可信区间，1.1 - 1.3）对48小时的ALI有独立影响。基于对重症监护病房严重损伤患者的小型、前瞻性、描述性研究，我们确定肺损伤的存在对早期ALI的发生率影响最大。FFP输注量与早期ALI发生率之间也存在独立关系。需要进一步的研究来确定FFP输注引起的早期ALI对短期和长期生存的影响。
Background: Acute lung injury (ALI) is a syndrome consisting of noncardiogenic acute hypoxemic respiratory failure with the presence of bilateral pulmonary infiltrates and occurs in up to 33% of critically ill trauma patients. Retrospective and observational studies have suggested that a blood component resuscitation strategy using equal ratios of packed red blood cells (PRBCs) and fresh frozen plasma (FFP) may have a survival benefit in combat casualties. The purpose of this study was to determine whether this strategy is associated with an increased incidence of ALI.Methods: We performed a prospective observational study of all injured patients admitted to an intensive care unit (ICU) at a combat support hospital who required >5 units of blood transfusion within the first 24 hours of admission. Baseline demographic data along with Injury Severity Score (ISS), pulmonary injury, presence of long bone fracture, blood products transfused, mechanical ventilation data, and arterial blood gas analysis were collected. The primary endpoint of the study was the development of ALI at 48 hours after injury. Those who did not survive to ICU admission were excluded from analysis. Follow-up (including mortality) longer than 48 hours was unavailable secondary to rapid transfer out of our facility. A multivariate logistic regression was performed to determine the independent effects of variables on the incidence of early ALI.Results: During a 12-month period (from January 2008 to December 2008), 87 subjects were studied; of these, 66 patients met inclusion criteria, and 22 patients developed ALI at 48 hours (33%). Overall, the ratio of FFP to PRBC was 1:1.1. Those who developed ALI had a higher ISS (32 +/- 15 vs. 26 +/- 11; p = 0.04) and received more units of FFP (22 +/- 15 vs. 12 +/- 7; p < 0.001), PRBCs (22 +/- 16 vs. 13 +/- 7; p = 0.008), and platelets (5 +/- 11 vs. 1 +/- 2; p = 0.004) compared with those who did not develop ALI. Multivariate logistic regression analysis revealed that presence of pulmonary injury (odds ratio, 5.4; 95% confidence interval, 1.3-21.9) and volume of FFP transfused (odds ratio, 1.2; 95% confidence interval, 1.1-1.3) had independent effects on ALI at 48 hours.Conclusion: On the basis of this small, prospective, descriptive study of severely injured patients admitted to the ICU, we determined that the presence of pulmonary injury had the greatest impact on the incidence of early ALI. There was also an independent relationship between the amount of FFP transfused and the incidence of early ALI. Further studies are required to determine the effects of the development of early ALI from FFP transfusion on short- and long-term survival.