Acute Respiratory Distress Syndrome in Wartime Military Burns: Application of the Berlin Criteria
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND Acute respiratory distress syndrome ARDS prevalence and related outcomes in burned military casualties from Iraq and Afghanistan have not been described previously. The objective of this article was to report ARDS prevalence and its associated in-hospital mortality in military burn patients. METHODS Demographic and physiologic data were collected retrospectively on mechanically ventilated military casualties admitted to our burn intensive care unit from January 2003 to December 2011. Patients with ARDS were identified in accordance with the new Berlin definition of ARDS. Subjects were categorized as having mild, moderate, or severe ARDS. Multivariate logistic regression identified independent risk factors for developing moderate-to-severe ARDS. The main outcome measure was the prevalence of ARDS in a cohort of patients burned as a result of recent combat operations. RESULTS A total of 876 burned military casualties presented during the study period, ofwhom291 33.2 required mechanical ventilation. Prevalence of ARDS in this cohort was 32.6, with a crude overall mortality of 16.5. Mortality increased significantly with ARDS severity mild 11.1, moderate 36.1, and severe 43.8 compared with no ARDS 8.7 p 0.001. Predictors for the development of moderate or severe ARDS were inhalation injury odds ratio OR, 1.90 95 confidence interval CI, 1.01-3.54 p 0.046, Injury Severity Score ISS OR, 1.04 95CI, 1.01-1.07 p 0.0021, pneumonia OR, 198 95CI, 1.07-3.66 p 0.03, and transfusion of fresh frozen plasma OR, 1.32 95 CI, 1.01-1.72 p 0.04. Size of burn was associated with moderate or severe ARDS by univariate analysis but was not an independent predictor of ARDS by multivariate logistic regression p 0.05. Age, size of burn, and moderate or severe ARDS were independent predictors of mortality.
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