Background Elevated blood alcohol content is a risk factor for injury. Associations of blood alcohol content with acute respiratory distress syndrome have not been conclusively established. We evaluated the association of a BAC >0 mg/dL with the intermediate outcomes, Injury Severity Score and Glasgow Coma Score, and their association with acute respiratory distress syndrome development. Methods Observational retrospective cohort study of 26,305 primary trauma admissions to a statewide referral trauma center from July 11, 2003 to October 31, 2011. Logistic regression was performed to assess the relationship between Admission blood alcohol content, Injury Severity Score, Glasgow Coma Score, and acute respiratory distress syndrome development within five days of admission. Results The case-rate for acute respiratory distress syndrome was 5.5% (1447). Blood alcohol content >0 mg/dL was associated with acute respiratory distress syndrome development in adjusted analysis (Odds Ratio 1.50; 95% Confidence Interval 1.33–1.71, p<0.001). High Injury Severity Score (≥16) had a stronger association with acute respiratory distress syndrome development (Odds Ratio 17.99; 95% Confidence Interval 15.51–20.86); as did low Glasgow Coma Score (≤8) (Odds Ratio 8.77; 95% Confidence Interval 7.64–10.07, p<0.001). Patients with low Glasgow Coma Score and high Injury Severity Score had the most frequent acute respiratory distress syndrome (33.6%) and the highest case fatality rate without acute respiratory distress syndrome (24.7%). Conclusions Elevated blood alcohol content is associated with acute respiratory distress syndrome development. In the analysis of alcohol exposure, Injury Severity Score and Glasgow Coma Score occur after alcohol ingestion, making them intermediate outcomes. Injury Severity Score and Glasgow Coma Score were strong predictors of acute respiratory distress syndrome and may be useful to identify at-risk patients. Elevated blood alcohol content may increase the frequency of the acute respiratory distress syndrome through influence on injury severity or independent molecular mechanisms which can be discriminated only in experimental models

Purpose Assess the case rate of Acute Respiratory Distress Syndrome (ARDS) after near-hanging, and the secondary outcomes of traumatic and/or anoxic brain injury, and death. Risk factors for the outcomes were assessed. Method Single-center, state-wide retrospective cohort study of consecutive patients admitted between August, 2002, and September, 2011, with a primary diagnosis of non-judicial "hanging injury". Results Of 56 patients, 73% were male. The median age was 31 (IQR: 16–56). Upon arrival, 9% (5/56) did not have a pulse, and 23% (13/56) patients were intubated. The median Glasgow Coma Scale (GCS) was 13 (IQR: 3–15); 14% (8/56) had a GCS=3. ARDS developed in 9% (5/56) of patients. Traumatic anoxic brain injury resulted in 9% (5/56) of patients. The in-hospital case fatality was 5% (3/56). Lower median GCS [3 (IQR: 3–7) vs. 14 (IQR: 3–15), p=0.0003] and intubation in field or in trauma resuscitation unit [100% (5/5) vs. 16% (8/51), p=0.0003] were associated with ARDS development. Risk factors of death were GCS=3 [100% (3/3) vs. 9% (5/53), p=0.002]; pulselessness upon arrival of emergency medical services [100% (3/3) vs. 4% (2/53), p<0.001]; and abnormal neurologic imaging [50% (1/2) vs. zero, p=0.04]. Conclusions The ARDS case rate after near-hanging is similar to the general trauma population. Low GCS and intubation are associated with increased risk of ARDS development. The rate of traumatic and/or anoxic brain injury in this population is low.

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IntroductionAn airway exchange catheter is a hollow-lumen tube able to deliver oxygen and maintain access to a difficult endotracheal airway. This case report demonstrates an undocumented complication associated with an airway exchange catheter and jet ventilation, particularly in a patient with reduced airway diameter due to thick endotracheal secretions. Due to the frequent use of airway exchange catheters in the intensive care unit, this report highlights an adverse event of bilateral pneumothoraces that can be encountered by clinicians.Case PresentationThis case report describes a 24-year-old female with severe adult respiratory distress syndrome and thick endotra-cheal secretions whose hospital course was complicated by bilateral pneumothoraces resulting from the use of an airway exchange catheter connected to jet ventilation. During the exchange, the catheter occluded the narrowed endotracheal tube to create a one-way valve that led to excessive lung inflation.ConclusionAirway exchange catheters used with jet ventilation in a patient with a narrowed endotracheal tube and reduced lung compliance have the potential risk of causing a pneumothorax. Clinicians should avoid temporary concomitant oxygenation via jet ventilation in patients with these findings and reserve the use of airway exchange catheters for difficult airways.