Adult respiratory distress syndrome: a complication of induced hypertension after severe head injury

Object. The factors involved in the development of adult respiratory distre ss syndrome (ARDS) after severe head injury were studied. The presence of A RDS complicates the treatment of patients with severe head injury, both bec ause hypoxia causes additional injury to the brain and because therapies th at are used to protect the lungs and improve oxygenation in patients with A RDS can reduce cerebral blood flow (CBF) and increase intracranial pressure (ICP). In a recent randomized trial of two head-injury management strategi es (ICP-targeted and CBF-targeted), a fivefold increase in the incidence of ARDS was observed in the CBF-targeted group. Methods. Injury severity, physiological data, and treatment data in 18 pati ents in whom ARDS had developed were compared with the remaining 171 patien ts in the randomized trial in whom it had not developed. Logistic regressio n analysis was used to study the interaction of the factors that were relat ed to the development of ARDS. In the final exact logistic regression model, several factors were found to be significantly associated with an increased risk of ARDS: administration of epinephrine (5.7-fold increased risk), administration of dopamine in a larger than median dose (10.8-fold increased risk), and a history of drug a buse (3.1-fold increased risk). Conclusions. Although this clinical trial was not designed to study the ass ociation of management strategy and the occurrence of ARDS, the data strong ly indicated that induced hypertension in this high-risk group of patients is associated with the development of symptomatic ARDS.