Application of the Berlin definition in PROMMTT patients: The impact of resuscitation on the incidence of hypoxemia

Bryce R H Robinson, Bryan A. Cotton, Timothy A. Pritts, Richard Branson, John B. Holcomb, Peter Muskat, Erin E. Fox, Charles E. Wade, Deborah J. Del Junco, Eileen M. Bulger, Mitchell J. Cohen, Martin Schreiber, John G. Myers, Karen Brasel, Herb A. Phelan, Louis H. Alarcon, Mohammad H. Rahbar, Rachael A. Callcut

    Research output: Contribution to journalArticle

    32 Citations (Scopus)

    Abstract

    BACKGROUND: Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. METHODS: Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis. Hypoxemia was categorized using the Berlin definition for adult respiratory distress syndrome: none (PaO2-to-FIO2 ratio [P/F] > 300 mm Hg), mild (P/F, 201-300 mm Hg), moderate (P/F, 101-200 mm Hg) or severe (P/F ≤ 100 mm Hg). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0 hour to 6 hours from arrival; late resuscitation was defined as that occurring 7 hours to 24 hours. Multivariate logistic regression models were developed controlling for age, sex, mechanisms of injury, arrival physiology, individual Abbreviated Injury Scale (AIS) scores, blood transfusions, and crystalloid administration. RESULTS: Of the patients 58.7% (731 of 1,245) met inclusion criteria. Hypoxemia occurred in 69% (mild, 24%; moderate, 28%; severe, 17%). Mortality was highest (24%) in the severe group. During early resuscitation (0Y6 h), logistic regression revealed age (odd ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.04), chest AIS score (OR, 1.31; 95% CI, 1.10-1.57), and intravenously administered crystalloid fluids given in 500 mL increments (OR, 1.12; 95% CI, 1.01-1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR, 1.02; 95% CI, 1.00-1.04), chest AIS score (OR, 1.33; 95% CI, 1.11-1.59), and crystalloids given during this period (OR, 1.05; 95% CI, 1.01-1.10) were also predictive of moderate-to-severe hypoxemia. Red blood cell, plasma, and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. CONCLUSION: Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    Volume75
    Issue number1 SUPPL1
    DOIs
    StatePublished - 2013

    Fingerprint

    Berlin
    Resuscitation
    Odds Ratio
    Incidence
    Abbreviated Injury Scale
    Confidence Intervals
    Thoracic Injuries
    Logistic Models
    Wounds and Injuries
    Blood Transfusion
    Erythrocyte Transfusion
    Platelet Transfusion
    Hypoxia
    Acute Lung Injury
    Adult Respiratory Distress Syndrome
    Intensive Care Units
    Survival
    Mortality
    crystalloid solutions
    Population

    Keywords

    • Hypoxemia
    • Lung injury
    • PROMMTT
    • Resuscitation
    • Trauma

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Robinson, B. R. H., Cotton, B. A., Pritts, T. A., Branson, R., Holcomb, J. B., Muskat, P., ... Callcut, R. A. (2013). Application of the Berlin definition in PROMMTT patients: The impact of resuscitation on the incidence of hypoxemia. Journal of Trauma and Acute Care Surgery, 75(1 SUPPL1). https://doi.org/10.1097/TA.0b013e31828fa408

    Application of the Berlin definition in PROMMTT patients : The impact of resuscitation on the incidence of hypoxemia. / Robinson, Bryce R H; Cotton, Bryan A.; Pritts, Timothy A.; Branson, Richard; Holcomb, John B.; Muskat, Peter; Fox, Erin E.; Wade, Charles E.; Del Junco, Deborah J.; Bulger, Eileen M.; Cohen, Mitchell J.; Schreiber, Martin; Myers, John G.; Brasel, Karen; Phelan, Herb A.; Alarcon, Louis H.; Rahbar, Mohammad H.; Callcut, Rachael A.

    In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1 SUPPL1, 2013.

    Research output: Contribution to journalArticle

    Robinson, BRH, Cotton, BA, Pritts, TA, Branson, R, Holcomb, JB, Muskat, P, Fox, EE, Wade, CE, Del Junco, DJ, Bulger, EM, Cohen, MJ, Schreiber, M, Myers, JG, Brasel, K, Phelan, HA, Alarcon, LH, Rahbar, MH & Callcut, RA 2013, 'Application of the Berlin definition in PROMMTT patients: The impact of resuscitation on the incidence of hypoxemia', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1 SUPPL1. https://doi.org/10.1097/TA.0b013e31828fa408
    Robinson, Bryce R H ; Cotton, Bryan A. ; Pritts, Timothy A. ; Branson, Richard ; Holcomb, John B. ; Muskat, Peter ; Fox, Erin E. ; Wade, Charles E. ; Del Junco, Deborah J. ; Bulger, Eileen M. ; Cohen, Mitchell J. ; Schreiber, Martin ; Myers, John G. ; Brasel, Karen ; Phelan, Herb A. ; Alarcon, Louis H. ; Rahbar, Mohammad H. ; Callcut, Rachael A. / Application of the Berlin definition in PROMMTT patients : The impact of resuscitation on the incidence of hypoxemia. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1 SUPPL1.
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    abstract = "BACKGROUND: Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. METHODS: Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis. Hypoxemia was categorized using the Berlin definition for adult respiratory distress syndrome: none (PaO2-to-FIO2 ratio [P/F] > 300 mm Hg), mild (P/F, 201-300 mm Hg), moderate (P/F, 101-200 mm Hg) or severe (P/F ≤ 100 mm Hg). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0 hour to 6 hours from arrival; late resuscitation was defined as that occurring 7 hours to 24 hours. Multivariate logistic regression models were developed controlling for age, sex, mechanisms of injury, arrival physiology, individual Abbreviated Injury Scale (AIS) scores, blood transfusions, and crystalloid administration. RESULTS: Of the patients 58.7{\%} (731 of 1,245) met inclusion criteria. Hypoxemia occurred in 69{\%} (mild, 24{\%}; moderate, 28{\%}; severe, 17{\%}). Mortality was highest (24{\%}) in the severe group. During early resuscitation (0Y6 h), logistic regression revealed age (odd ratio [OR], 1.02; 95{\%} confidence interval [CI], 1.00-1.04), chest AIS score (OR, 1.31; 95{\%} CI, 1.10-1.57), and intravenously administered crystalloid fluids given in 500 mL increments (OR, 1.12; 95{\%} CI, 1.01-1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR, 1.02; 95{\%} CI, 1.00-1.04), chest AIS score (OR, 1.33; 95{\%} CI, 1.11-1.59), and crystalloids given during this period (OR, 1.05; 95{\%} CI, 1.01-1.10) were also predictive of moderate-to-severe hypoxemia. Red blood cell, plasma, and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. CONCLUSION: Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.",
    keywords = "Hypoxemia, Lung injury, PROMMTT, Resuscitation, Trauma",
    author = "Robinson, {Bryce R H} and Cotton, {Bryan A.} and Pritts, {Timothy A.} and Richard Branson and Holcomb, {John B.} and Peter Muskat and Fox, {Erin E.} and Wade, {Charles E.} and {Del Junco}, {Deborah J.} and Bulger, {Eileen M.} and Cohen, {Mitchell J.} and Martin Schreiber and Myers, {John G.} and Karen Brasel and Phelan, {Herb A.} and Alarcon, {Louis H.} and Rahbar, {Mohammad H.} and Callcut, {Rachael A.}",
    year = "2013",
    doi = "10.1097/TA.0b013e31828fa408",
    language = "English (US)",
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    TY - JOUR

    T1 - Application of the Berlin definition in PROMMTT patients

    T2 - The impact of resuscitation on the incidence of hypoxemia

    AU - Robinson, Bryce R H

    AU - Cotton, Bryan A.

    AU - Pritts, Timothy A.

    AU - Branson, Richard

    AU - Holcomb, John B.

    AU - Muskat, Peter

    AU - Fox, Erin E.

    AU - Wade, Charles E.

    AU - Del Junco, Deborah J.

    AU - Bulger, Eileen M.

    AU - Cohen, Mitchell J.

    AU - Schreiber, Martin

    AU - Myers, John G.

    AU - Brasel, Karen

    AU - Phelan, Herb A.

    AU - Alarcon, Louis H.

    AU - Rahbar, Mohammad H.

    AU - Callcut, Rachael A.

    PY - 2013

    Y1 - 2013

    N2 - BACKGROUND: Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. METHODS: Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis. Hypoxemia was categorized using the Berlin definition for adult respiratory distress syndrome: none (PaO2-to-FIO2 ratio [P/F] > 300 mm Hg), mild (P/F, 201-300 mm Hg), moderate (P/F, 101-200 mm Hg) or severe (P/F ≤ 100 mm Hg). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0 hour to 6 hours from arrival; late resuscitation was defined as that occurring 7 hours to 24 hours. Multivariate logistic regression models were developed controlling for age, sex, mechanisms of injury, arrival physiology, individual Abbreviated Injury Scale (AIS) scores, blood transfusions, and crystalloid administration. RESULTS: Of the patients 58.7% (731 of 1,245) met inclusion criteria. Hypoxemia occurred in 69% (mild, 24%; moderate, 28%; severe, 17%). Mortality was highest (24%) in the severe group. During early resuscitation (0Y6 h), logistic regression revealed age (odd ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.04), chest AIS score (OR, 1.31; 95% CI, 1.10-1.57), and intravenously administered crystalloid fluids given in 500 mL increments (OR, 1.12; 95% CI, 1.01-1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR, 1.02; 95% CI, 1.00-1.04), chest AIS score (OR, 1.33; 95% CI, 1.11-1.59), and crystalloids given during this period (OR, 1.05; 95% CI, 1.01-1.10) were also predictive of moderate-to-severe hypoxemia. Red blood cell, plasma, and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. CONCLUSION: Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.

    AB - BACKGROUND: Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. METHODS: Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis. Hypoxemia was categorized using the Berlin definition for adult respiratory distress syndrome: none (PaO2-to-FIO2 ratio [P/F] > 300 mm Hg), mild (P/F, 201-300 mm Hg), moderate (P/F, 101-200 mm Hg) or severe (P/F ≤ 100 mm Hg). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0 hour to 6 hours from arrival; late resuscitation was defined as that occurring 7 hours to 24 hours. Multivariate logistic regression models were developed controlling for age, sex, mechanisms of injury, arrival physiology, individual Abbreviated Injury Scale (AIS) scores, blood transfusions, and crystalloid administration. RESULTS: Of the patients 58.7% (731 of 1,245) met inclusion criteria. Hypoxemia occurred in 69% (mild, 24%; moderate, 28%; severe, 17%). Mortality was highest (24%) in the severe group. During early resuscitation (0Y6 h), logistic regression revealed age (odd ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.04), chest AIS score (OR, 1.31; 95% CI, 1.10-1.57), and intravenously administered crystalloid fluids given in 500 mL increments (OR, 1.12; 95% CI, 1.01-1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR, 1.02; 95% CI, 1.00-1.04), chest AIS score (OR, 1.33; 95% CI, 1.11-1.59), and crystalloids given during this period (OR, 1.05; 95% CI, 1.01-1.10) were also predictive of moderate-to-severe hypoxemia. Red blood cell, plasma, and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. CONCLUSION: Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.

    KW - Hypoxemia

    KW - Lung injury

    KW - PROMMTT

    KW - Resuscitation

    KW - Trauma

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