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Moderate/severe acute respiratory distress syndrome in patients with or without traumatic brain injury

Introduction

Patients with traumatic brain injury are at risk of developing acute respiratory distress syndrome, which significantly increases morbidity. This study aimed to assess functional difference (respiratory mechanics) and morbidity and mortality of moderate/severe acute respiratory distress syndrome among patients with traumatic brain injury compared with those with other non-traumatic aetiologies, besides assessing the outcomes of patients with severe traumatic brain injury with or without moderate/severe acute respiratory distress syndrome.

Methods

A prospective cohort study analysed consecutive patients with moderate/severe acute respiratory distress syndrome (PaO2/FiO2 < 200) and consecutive patients with traumatic brain injury during a 14-month period in the general intensive care unit of a teaching hospital in Cascavel, southern Brazil.

Results

Overall, 85 patients were assessed: 30 with traumatic brain injury without acute respiratory distress syndrome, 17 with traumatic brain injury and acute respiratory distress syndrome and 38 with non-traumatic brain injury (other aetiologies) acute respiratory distress syndrome. Acute respiratory distress syndrome in patients with traumatic brain injury resulted in a longer intensive care unit length of stay and slightly higher mortality. When acute respiratory distress syndrome patients with and without traumatic brain injury are compared, the latter required higher values of positive end expiratory pressure and showed a trend to lower lung static compliance, with slightly higher mortality.

Conclusions

In patients with traumatic brain injury, the presence of acute respiratory distress syndrome increased hospitalisation time. Patients with non-traumatic brain injury acute respiratory distress syndrome showed lower respiratory compliance and required higher values of positive end expiratory pressure than those with traumatic brain injury – acute respiratory distress syndrome, with higher mortality.