Trauma and acute lung injury

Abstract

Acute lung injury is a serious complication of major trauma occurring as a direct consequence of trauma to the lung or, more commonly, arising indirectly as a consequence of trauma elsewhere to the body. A spectrum of severity exists with acute respiratory distress syndrome (ARDS) defined as the most severe form of injury. The frequency of ARDS with severe trauma is unclear but is believed to occur in approximately 15- 25% of cases, although this is confused by the effects of multiple transfusions and associated injuries including burns and head injury. ARDS from all causes is estimated to occur with a frequency of two to 10 cases per 100 000 population. It causes a huge social and financial impact, with many survivors requiring a prolonged critical care stay and a significant number having a persisting poor quality of life a year after the injury. The mortality is, however, decreasing and stands at approximately 40%. A number of approaches are now recognized that can improve oxygenation and large trials have identified best critical care practice, leading to a reduction in ventilator-induced injury, with associated improvements in outcome.