Risk factors for the development of acute respiratory distress syndrome following hemorrhage

PROPPR Study Group

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study evaluated the effects of plasma and platelets on hemostasis and mortality after hemorrhage. The pulmonary consequences of resuscitation strategies that mimic whole blood, remain unknown. Methods: A secondary analysis of the PROPPR study was performed. Injured patients predicted to receive a massive transfusion were randomized to 1:1:1 versus 1:1:2 plasmaplatelet- red blood cell ratios at 12 Level I North American trauma centers. Patients with survival >24 h, an intensive care unit (ICU) stay, and a recorded PaO2/FiO2 (P/F) ratio were included. Acute respiratory distress syndrome (ARDS) was defined as a P/F ratio<200, with bilateral pulmonary infiltrates, and adjudicated by investigators. Results: Four hundred fifty-four patients were reviewed (230 received 1:1:1, 224 1:1:2). Age, sex, injury mechanism, and regional abbreviated injury scale (AIS) scores did not differ between cohorts. Tidal volume, positive end-expiratory pressure, and lowest P/F ratio did not differ. No significant differences in ARDS rates (14.8% vs. 18.4%), ventilator-free (24 vs. 24) or ICU-free days (17.5 vs. 18), hospital length of stay (22 days vs. 18 days), or 30-day mortality were found (28% vs. 28%). ARDS was associated with blunt injury (OR 3.61 [1.53-8.81] P<0.01) and increasing chest AIS (OR 1.40 [1.15-1.71] P<0.01). Each 500mL of crystalloid infused during hours 0 to 6 was associated with a 9% increase in the rate of ARDS (OR 1.09 [1.04-1.14] P<0.01). Blood given at 0 to 6 or 7 to 24 h were not risk factors for lung injury. Conclusion: Acute crystalloid exposure, but not blood products, is a potentially modifiable risk factor for the prevention of ARDS following hemorrhage.

Original languageEnglish (US)
Pages (from-to)258-264
Number of pages7
JournalShock
Volume50
Issue number3
DOIs
StatePublished - Jan 1 2018

Fingerprint

Adult Respiratory Distress Syndrome
Hemorrhage
Abbreviated Injury Scale
Blood Platelets
Intensive Care Units
Length of Stay
Lung
Thoracic Injuries
Nonpenetrating Wounds
Positive-Pressure Respiration
Mortality
Trauma Centers
Tidal Volume
Lung Injury
Mechanical Ventilators
Hemostasis
Resuscitation
Erythrocytes
Research Personnel
Survival

Keywords

  • Damage control resuscitation
  • Lung injury
  • Massive hemorrhage
  • Resuscitation
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Risk factors for the development of acute respiratory distress syndrome following hemorrhage. / PROPPR Study Group.

In: Shock, Vol. 50, No. 3, 01.01.2018, p. 258-264.

Research output: Contribution to journalArticle

PROPPR Study Group. / Risk factors for the development of acute respiratory distress syndrome following hemorrhage. In: Shock. 2018 ; Vol. 50, No. 3. pp. 258-264.
@article{db5dc5125e834d52aaea167fb02a7e5b,
title = "Risk factors for the development of acute respiratory distress syndrome following hemorrhage",
abstract = "Background: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study evaluated the effects of plasma and platelets on hemostasis and mortality after hemorrhage. The pulmonary consequences of resuscitation strategies that mimic whole blood, remain unknown. Methods: A secondary analysis of the PROPPR study was performed. Injured patients predicted to receive a massive transfusion were randomized to 1:1:1 versus 1:1:2 plasmaplatelet- red blood cell ratios at 12 Level I North American trauma centers. Patients with survival >24 h, an intensive care unit (ICU) stay, and a recorded PaO2/FiO2 (P/F) ratio were included. Acute respiratory distress syndrome (ARDS) was defined as a P/F ratio<200, with bilateral pulmonary infiltrates, and adjudicated by investigators. Results: Four hundred fifty-four patients were reviewed (230 received 1:1:1, 224 1:1:2). Age, sex, injury mechanism, and regional abbreviated injury scale (AIS) scores did not differ between cohorts. Tidal volume, positive end-expiratory pressure, and lowest P/F ratio did not differ. No significant differences in ARDS rates (14.8{\%} vs. 18.4{\%}), ventilator-free (24 vs. 24) or ICU-free days (17.5 vs. 18), hospital length of stay (22 days vs. 18 days), or 30-day mortality were found (28{\%} vs. 28{\%}). ARDS was associated with blunt injury (OR 3.61 [1.53-8.81] P<0.01) and increasing chest AIS (OR 1.40 [1.15-1.71] P<0.01). Each 500mL of crystalloid infused during hours 0 to 6 was associated with a 9{\%} increase in the rate of ARDS (OR 1.09 [1.04-1.14] P<0.01). Blood given at 0 to 6 or 7 to 24 h were not risk factors for lung injury. Conclusion: Acute crystalloid exposure, but not blood products, is a potentially modifiable risk factor for the prevention of ARDS following hemorrhage.",
keywords = "Damage control resuscitation, Lung injury, Massive hemorrhage, Resuscitation, Trauma",
author = "{PROPPR Study Group} and Robinson, {Bryce R.H.} and Cohen, {Mitchell J.} and Holcomb, {John B.} and Pritts, {Timothy A.} and Dina Gomaa and Fox, {Erin E.} and Branson, {Richard D.} and Callcut, {Rachael A.} and Cotton, {Bryan A.} and Martin Schreiber and Karen Brasel and Pittet, {Jean Francois} and Kenji Inaba and Kerby, {Jeffery D.} and Scalea, {Thomas M.} and Wade, {Charlie E.} and Bulger, {Eileen M.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/SHK.0000000000001073",
language = "English (US)",
volume = "50",
pages = "258--264",
journal = "Shock",
issn = "1073-2322",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Risk factors for the development of acute respiratory distress syndrome following hemorrhage

AU - PROPPR Study Group

AU - Robinson, Bryce R.H.

AU - Cohen, Mitchell J.

AU - Holcomb, John B.

AU - Pritts, Timothy A.

AU - Gomaa, Dina

AU - Fox, Erin E.

AU - Branson, Richard D.

AU - Callcut, Rachael A.

AU - Cotton, Bryan A.

AU - Schreiber, Martin

AU - Brasel, Karen

AU - Pittet, Jean Francois

AU - Inaba, Kenji

AU - Kerby, Jeffery D.

AU - Scalea, Thomas M.

AU - Wade, Charlie E.

AU - Bulger, Eileen M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study evaluated the effects of plasma and platelets on hemostasis and mortality after hemorrhage. The pulmonary consequences of resuscitation strategies that mimic whole blood, remain unknown. Methods: A secondary analysis of the PROPPR study was performed. Injured patients predicted to receive a massive transfusion were randomized to 1:1:1 versus 1:1:2 plasmaplatelet- red blood cell ratios at 12 Level I North American trauma centers. Patients with survival >24 h, an intensive care unit (ICU) stay, and a recorded PaO2/FiO2 (P/F) ratio were included. Acute respiratory distress syndrome (ARDS) was defined as a P/F ratio<200, with bilateral pulmonary infiltrates, and adjudicated by investigators. Results: Four hundred fifty-four patients were reviewed (230 received 1:1:1, 224 1:1:2). Age, sex, injury mechanism, and regional abbreviated injury scale (AIS) scores did not differ between cohorts. Tidal volume, positive end-expiratory pressure, and lowest P/F ratio did not differ. No significant differences in ARDS rates (14.8% vs. 18.4%), ventilator-free (24 vs. 24) or ICU-free days (17.5 vs. 18), hospital length of stay (22 days vs. 18 days), or 30-day mortality were found (28% vs. 28%). ARDS was associated with blunt injury (OR 3.61 [1.53-8.81] P<0.01) and increasing chest AIS (OR 1.40 [1.15-1.71] P<0.01). Each 500mL of crystalloid infused during hours 0 to 6 was associated with a 9% increase in the rate of ARDS (OR 1.09 [1.04-1.14] P<0.01). Blood given at 0 to 6 or 7 to 24 h were not risk factors for lung injury. Conclusion: Acute crystalloid exposure, but not blood products, is a potentially modifiable risk factor for the prevention of ARDS following hemorrhage.

AB - Background: The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study evaluated the effects of plasma and platelets on hemostasis and mortality after hemorrhage. The pulmonary consequences of resuscitation strategies that mimic whole blood, remain unknown. Methods: A secondary analysis of the PROPPR study was performed. Injured patients predicted to receive a massive transfusion were randomized to 1:1:1 versus 1:1:2 plasmaplatelet- red blood cell ratios at 12 Level I North American trauma centers. Patients with survival >24 h, an intensive care unit (ICU) stay, and a recorded PaO2/FiO2 (P/F) ratio were included. Acute respiratory distress syndrome (ARDS) was defined as a P/F ratio<200, with bilateral pulmonary infiltrates, and adjudicated by investigators. Results: Four hundred fifty-four patients were reviewed (230 received 1:1:1, 224 1:1:2). Age, sex, injury mechanism, and regional abbreviated injury scale (AIS) scores did not differ between cohorts. Tidal volume, positive end-expiratory pressure, and lowest P/F ratio did not differ. No significant differences in ARDS rates (14.8% vs. 18.4%), ventilator-free (24 vs. 24) or ICU-free days (17.5 vs. 18), hospital length of stay (22 days vs. 18 days), or 30-day mortality were found (28% vs. 28%). ARDS was associated with blunt injury (OR 3.61 [1.53-8.81] P<0.01) and increasing chest AIS (OR 1.40 [1.15-1.71] P<0.01). Each 500mL of crystalloid infused during hours 0 to 6 was associated with a 9% increase in the rate of ARDS (OR 1.09 [1.04-1.14] P<0.01). Blood given at 0 to 6 or 7 to 24 h were not risk factors for lung injury. Conclusion: Acute crystalloid exposure, but not blood products, is a potentially modifiable risk factor for the prevention of ARDS following hemorrhage.

KW - Damage control resuscitation

KW - Lung injury

KW - Massive hemorrhage

KW - Resuscitation

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=85050158396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050158396&partnerID=8YFLogxK

U2 - 10.1097/SHK.0000000000001073

DO - 10.1097/SHK.0000000000001073

M3 - Article

VL - 50

SP - 258

EP - 264

JO - Shock

JF - Shock

SN - 1073-2322

IS - 3

ER -