Early post-traumatic acute respiratory distress syndrome and albumin excretion rate: a prospective evaluation of a 'point-of care' predictive test

All patients sustaining major trauma exhibit increased capillary permeabili ty, manifested as micro-albuminuria. Urinary albumin excretion rate (AER) m easured on intensive care units (ICU) can predict early post-traumatic acut e respiratory distress syndrome (ARDS). This prospective study sought to ev aluate AER as a practical predictive test for early ARDS. Staff at the part icipating centres were trained in the use of the Behring Turbitimer and the concept of AER as a predictor of early post-traumatic ARDS. AER was measur ed every 2 h for the first 24 h, on 54 adult blunt trauma admissions (ISS g reater than or equal to 18). A diagnosis of early acute lung injury (ALI) o r ARDS was made using the American-European Consensus Conference criteria. Eleven patients developed ARDS, ten developed ALI, and 23 had no pulmonary dysfunction. The AER was significantly greater in those who developed ARDS 8 and 18 h after admission. The positive predictive value of the test was 6 4% at 8 h, the negative predictive power 73%. The test was performed most c onsistently in the middle 10 h of the study period. If intervention had bee n based on the 8 h data point result, 75% patients who had the test perform ed and later developed ARDS would have had intervention appropriately. In p rinciple, testing for AER as a predictor of post-traumatic ARDS on ICU is f easible, however, this study has underlined the challenges of introducing n ew concepts into the ICU environment. (C) 2001 Elsevier Science Ltd. All ri ghts reserved.