Rationale: It is commonly stated that mortality from acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) is decreasing.Objectives: To systematically review the literature assessing ARDS mortality over time and to determine patient- and study-level factors independently associated with mortality.Methods: We searched multiple databases (MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL) for prospective observational studies or randomized controlled trials (RCTs) published during the period 1984 to 2006 that enrolled 50 or more patients with ALI/ARDS and reported mortality. We pooled mortality estimates using random-effects meta-analysis and examined mortality trends before and after 1994 (when a consensus definition of ALI/ARDS was published) and factors associated with mortality using meta-regression models.Measurements and Main Results: Of 4,966 studies, 89 met inclusion criteria (53 observational, 36 RCTs). There was a total of 18,900 patients (mean age 51.6 years; 39% female). Overall pooled ...

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Has mortality from acute respiratory distress syndrome decreased over time?: A systematic review.

Background: As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe consequences from traumatic injuries compared with the young, presumably resulting in increased resource use. In this study, we sought to examine ICU resource use in trauma on the basis of age and injury severity. Methods: This study was a retrospective review of trauma registry data prospectively collected on 26,237 blunt trauma patients admitted to all trauma centers (n = 26) in one state over 24 months (January 1996-December 1997). Age-dependent and injury severity-dependent differences in mortality, ICU length of stay (LOS), and hospital LOS were evaluated by logistic regression analysis. Results: Elderly (age ≥ 65 years, n = 7,117) patients had significantly higher mortality rates than younger (age 65 years was associ ated with a two- to threefold increases mortality risk in mild (ISS 30) have decreased ICU resource use secondary to associated increased mortality rates.

Trauma in the elderly: intensive care unit resource use and outcome.

Objective:To review the use of airway pressure release ventilation (APRV) in the treatment of acute lung injury/acute respiratory distress syndrome.Data Source:Published animal studies, human studies, and review articles of APRV.Data Summary:APRV has been successfully used in neonatal, pediatric, an

Other approaches to open-lung ventilation: airway pressure release ventilation.

Sex differences in the incidence and severity of respiratory tract infections

Blunt aortic injury occurs after sudden deceleration, and it is second only to head injury as the leading cause of death after automobile crashes. Helical computed tomography of the thorax is more ...

https://www.nejm.org/doi/pdf/10.1056/NEJMra0706159

Blunt aortic injury.

BackgroundHigh testosterone and low estradiol levels induce immunosuppression and adverse outcome after trauma in male animals. Gender-based outcome differences in human trauma have not been investigated. In order to test our hypothesis that female gender is associated with improved outcome after tr

Gender differences in adverse outcomes after blunt trauma

Objective: To evaluate trends in mortality and related factors among trauma patients who developed acute respiratory distress syndrome (ARDS). Study: Observational study based on data prospectively gathered in computerized trauma registry. Setting: Trauma intensive care unit (ICU) of 48 beds in level I trauma center. Patients: All trauma patients with ARDS admitted during 1985–87 (486, group 1 [G1]) and 1993–95 (552, group 2[G2]). Methods: ARDS was defined by American-European Consensus Conference criteria and the need for 48 h or more on mechanical ventilation with FI02 greater than 0.50 and PEEP of more than 5 cmH20. Demographics, severity score, injury-admission delay time, first 24-h transfusion and septic and organ system failure complications were independent variables. ICU mortality was the dependent variable. ICU length of stay (LOS) and life support techniques were considered. Respiratory and renal support strategies were different in the two time periods. Results: Mortality decreased over the period (G1: 29.2% vs G2: 21.4%, p<0.04), in patients aged both over and under 65 years. Multivariate analysis showed mortality was related to age, severity and time period (G1 1.68-fold that in G2) and that the greater G1 mortality was related to more renal failure and hematologic failure/dysfunction. ICU LOS decreased from 31.7±26.7 days (G1) to 27.3±22 days (G2) (p<0.003). Conclusions: Mortality among trauma patients with ARDS declined over the 8 years studied and was associated with less organ failure. This reduction was probably the result of new approaches to mechanical ventilation, renal failure replacement and vasoactive drug therapy.

Robert S. West

Papers

Gender differences in adverse outcomes after blunt trauma

Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization.

Traumatic aortic rupture: recent outcome with regard to neurologic deficit

Adult respiratory distress syndrome among blunt and penetrating trauma patients: Demographics, mortality, and resource utilization over 8 years ☆