Trauma-adult respiratory distress syndrome
Walker, M.L.
Journal of the National Medical Association 83(6): 501-504
1991
ISSN/ISBN: 0027-9684 PMID: 1865500 Document Number: 380814
Sixteen trauma victims with adult respiratory distress syndrome were retrospectively examined. High injury severity score (mean: 44), massive transfusion requirements, and prolonged ventilator days characterize this group. Persistent intra-abdominal infection accounted for two of three deaths in this series. Most of these patients were managed without paralysis using intermittent mandatory ventilation and positive-end expiratory pressure (PEEP). High frequency jet ventilation was necessary in one subject. Two patients exhibited early ARDS reversal, ie, clinical improvement, better chest x-ray and decreased shunt (within 72 hours) when an intra-abdominal septic focus was eradicated. Principles of critical care for these patients remain: an FiO2 less than .40, limiting barotrauma, using PEEP for alveolar recruitment and close monitoring of O2 transport.