Acute Lung Injury in Isolated Traumatic Brain Injury

TLDR

The study aimed to assess the incidence of acute lung injury in comatose patients with isolated traumatic brain injury, its association with specific brain lesions, and the resulting outcomes. The authors conducted a descriptive epidemiology and case‑control study using the Traumatic Coma Data Bank, defining ALI as a PaO₂/FiO₂ ratio ≤300, to evaluate clinical features and brain lesions in isolated head trauma patients. Among 100 comatose patients, 20 developed ALI, which was associated with a 2.8‑fold higher risk of death or vegetative state and with severe head injury severity (large mass lesions and midline shift), but not with specific CT‑identified lesions.

Abstract

OBJECTIVE: To determine the incidence of acute lung injury (ALI) in comatose patients after isolated traumatic brain injury, to determine whether specific brain lesions diagnosed by cranial computed tomographic scans are associated with ALI, and to determine the outcome of patients with head injuries who developed ALI. METHODS: Descriptive epidemiology and a case-control study using the Traumatic Coma Data Bank was performed to evaluate clinical features and brain lesions associated with ALI inpatients with isolated head trauma. Patients with ALI were defined as those who demonstrated a ratio of partial pressure of arterial oxygen to fractional expired oxygen of 300 or less. RESULTS: Twenty of 100 comatose patients developed ALI. Patients with ALI were almost three times more likely to die or survive in a vegetative state (odds ratio, 2.8; 95% confidence interval, 1.6-4.9). Specific anatomic brain lesions diagnosed by cranial computed tomographic scans were not associated with ALI. However, patients with more severe injuries, i.e., large nonevacuated mass lesions, and those with midline shift demonstrated a 10- and 5-fold increased risk of ALI (odds ratio, 9.9; 95% confidence interval, 1.2-217.1; and odds ratio, 5.5; 95% confidence interval, 1.5-20.0). CONCLUSIONS: ALI was common in comatose victims with an isolated traumatic brain injury and was associated with an increased risk of death or a severe neurological morbidity. ALI was associated with the global severity of head injury but not with specific anatomic lesions diagnosed by cranial computed tomographic scans.