Incidence, Risk Factors and Mortality Associated with Acute Respiratory Distress Syndrome (ARDS) in Combat Casualty Care.

Background: The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however the epidemiology and impact of ARDS on modern combat casualty care is unknown. We sought to determine the incidence, risk factors, resource utilization and mortality associated with ARDS in current combat casualty care. Methods: Retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (DODTR, formerly the Joint Theater Trauma Registry, JTTR) during Operation Iraqi Freedom/Enduring Freedom (10/2001-8/2008) for ARDS development, resource utilization and mortality. Results: Of 18,329 US DODTR encounters, 4679 (25.5%) required mechanical ventilation; ARDS was identified in 156 (3.3%). On multivariate logistic regression, ARDS was independently associated with female gender (OR 2.62, 95% CI 1.21-5.71, p=0.02), higher Mil ISS (OR 4.18, 95% CI 2.61-6.71, p= 25 vs. = 90 mm Hg, OR 1.76, 95% CI 1.07-2.88, p=0.03), and tachycardia (admission heart rate >= 90 bpm vs.

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