入室前访视对胃癌术后患者重症监护室综合征发生率的影响

目的探讨入重症监护室(intensive care unit,ICU)前访视对胃癌术后患者ICU综合征发生率的影响。方法2015年4-7月,便利抽样法选取在上海交通大学医学院附属新华医院外科ICU治疗的胃癌患者术后患者90例为研究对象,按其入住时间的先后分为对照组和观察组,每组45例。对照组患者在术后直接入住ICT,而观察组患者在术前由ICU护士进行入室前访视。从患者拔除口插管后开始观察并比较两组患者ICU综合征的发生情况及入住ICU治疗天数。结果对照组患者发生ICU综合征者17例,占37.8%;观察组中发生ICU综合征者8例,占17.8%,两组比较差异有统计学意义(x~2=4.491,P0.05)。对照组患者入住ICU治疗天数平均为(4.27±0.003)d,与观察组[(4.04±0.012)d]比较,差异无统计学意义(t=0.458,P=0.648)。结论人室前访视可降低胃癌术后患者ICU综合征的发生率,有助于其术后康复。     

重症监护病房患者低磷血症的发生及对预后的影响

目的 调查重症监护病房(ICU)患者低磷血症的发生情况,研究不同血磷水平对患者预后的影响.方法 观察2010年4月至11月入住盛京医院ICU 147例患者的血磷水平及低磷血症的发生率,比较轻、中、重度血磷水平患者间急性生理学与慢性健康状况评分系统Ⅱ( APACHEⅡ)评分、住ICU时间、主要实验室指标以及病死率的差异;比较生存和死亡患者住ICU期间血磷的变化.建立血磷水平与是否存活患者之间的受试者工作特征曲线(ROC曲线),探讨血磷水平对预测患者预后的意义.结果 77.6％的患者在入住ICU期间出现低磷,轻度21例、中度70例、重度23例,其中63.3％的患者出现中至重度的低磷;显著低磷的患者不仅APACHEⅡ评分(分)较高(轻度18.2±6.0,中度21.4±7.6,重度25.6±8.8,正常18.9±8.8),呼吸机使用时间(d)延长(轻度6.6±5.1,中度11.3±9.5,重度15.7±10.4,正常6.7±5.9),住ICU时间(d)较长(轻度9.7±6.4,中度10.6±8.2,重度18.9±13.1,正常9.9±7.1),而且病死率随之升高(轻度14.3％,中度25.7％,重度39.1％,正常9.1％).ICU患者的总病死率(22.4％)与低磷的程度呈显著负相关(r=-0.225,P=0.01);血磷＜0.40 mmol/L时预测患者存活的敏感性为78.6％,特异性为51.5％,提示预后较差.结论 大部分ICU患者血磷处于相对较低的水平.ICU患者容易合并低磷血症,重度低磷提示ICU患者预后较差.     

医源性高钠血症对危重症患者预后的影响

目的 探讨医源性高钠血症对危重症患者预后的影响以及危险程度.方法 回顾性分析2002年1月-2005年12月入住本院急诊重症监护病房(EICU)与外科重症监护病房(SICU)共1 568例患者的临床资料,按入院时及治疗过程中血清Na+浓度(至少1次≥149 mmol/L定义为高钠血症)分为医源性、非医源性高钠血症及非高钠血症组.将3组患者性别、年龄、住ICU时间、内科/外科系统疾病住院病因、住院后第1个24 h内急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分记录于本科建立的<危重症患者详尽资料数据库>中,建立Cox Regression生存模型进行分析.结果 1 568例患者中发生高钠血症361例(占23.0%),260例为医源性高钠血症(占16.6%).非医源性高钠血症患者的APACHEⅡ评分[(28.16±11.21)分]显著高于医源性高钠血症[(17.55±14.96)分]和非高钠血症[(16.02±10.77)分],医源性高钠血症患者的住ICU时间[(24.14±17.53)d]较非医源性高钠血症[(14.07±27.88)d]和非高钠血症[(13.14±10.53)d]明显延长,非医源性、医源性高钠血症患者28 d病死率(47.52%、42.31%)较非高钠血症患者(33.64%)明显增加,差异均有统计学意义(P<0.05或P<0.01).单变量及多变量Cox Regression生存分析模型显示,医源性高钠血症是患者预后的一项独立危险因素(单变量分析:危险比为1.83,95%可信区间为1.27～3.96,P<0.001;多变量分析:危险比为1.55,95%可信区间为1.17～3.10,P<0.001).结论 危重症患者医源性高钠血症可能是预后的一项独立危险因素,应严格予以避免,并在发生时予以积极正规的治疗.     

危重病人腹泻危险性评估方法及应用

[目的]探讨“危重病人腹泻危险性评估表”在重症监护病房(ICU)病人中应用的可行性。[方法]选择ICU病人(无原发胃肠道疾病)399例,应用“危重病人腹泻危险性评估表”进行动态评估,并根据评分进行分组,观察记录病人腹泻发生情况。[结果]危险性评分大于20分的病人腹泻发生率高。[结论]应早期对危重病人腹泻危险性进行评估,对评分大于20分的病人提早采取综合护理干预措施,以达到降低腹泻发生率、减少并发症的目的。     

血浆置换抢救重症肌无力危象病人的疗效分析

[目的]探讨血浆置换术(TPE)在抢救重症肌无力(myasthenia gravis,MG)危象病人中的临床疗效。[方法]应用Baxter AC-CURA机和配套滤器,对10例在专科病房行常规治疗效果不佳,转入重症监护病房(ICU)行呼吸机辅助呼吸的MG危象病人行TPE,观察病人呼吸机使用时间、ICU住院天数及治疗前后乙酰胆碱受体抗体(AchRAb)滴度变化。[结果]10例病人共行TPE治疗26例次,其中有6例3次,4例2次,平均2.8次,用呼吸机时间为7d～14d,平均9.9d,10例病人危象均迅速缓解,顺利脱离呼吸机,转普通病房进一步治疗,AchRAb滴度置换前为1.08nmol/L±0.24nmol/L,置换后为0.66nmol/L±0.45nmol/L。[结论]TPE抢救MG危象病人疗效迅速。     

儿科病房患儿抗生素相关性腹泻79例临床观察

[目的]分析儿科病房患儿抗生素相关性腹泻(AAD)的临床特点,探讨儿科AAD发生的影响因素.[方法]回顾性分析735例各种感染的患儿,根据有无发生AAD分为AAD组(79例)及无AAD组(656例),比较两组的临床资料(年龄、使用抗生素的种类、剂量、疗程等).[结果]本研究中AAD的发生率为10.7％(8/79),且均为单纯腹泻型.1岁以下占88.6％(70/79).导致ADD的最常见抗生素为头孢三代,占44.3％(35/79),且两种及三种联用者共占79.7％(64/79).ADD的发生与患儿年龄、抗生素种类应用及疗程、住院时间、禁食及采用医疗干预措施等危险因素有关.[结论]加强抗生素的合理应用,儿科用药宜选用窄谱抗生素,尤其对于1岁以下小儿,同时尽量单一短程应用抗生素,尽可能减少或避免ADD的发生.     

集束化治疗颅脑疾病呼吸机相关性肺炎的临床观察

目的 探讨集柬化(Bundle)治疗对重症监护病房(ICU)重型颅脑疾病患者呼吸机相关性肺炎(VAP)的临床疗效.方法 采用前瞻性随机对照试验,选择2009年3月1日至2011年7月1日入住ICU的颅脑疾病患者1 492例,最终诊断为VAP的患者57例,按随机数字表法分为Bundle治疗组(试验组,31例)和常规治疗组(对照组,26例).比较两组入住ICU的好转率、病死率、住ICU时间以及费用.结果 两组在年龄、性别、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、前降钙素原、诊断、合并症以及人工气道情况方面差异无统计学意义(均P＞ 0.05).试验组好转率较对照组明显升高(90.3％比65.4％,P=0.027),病死率较对照组明显降低(6.5％比30.8％,P=0.032),住ICU时间(d)明显少于对照组(12.16±5.14比16.54±4.80,P-- 0.002),入住ICU期间的总费用(万元)较对照组明显减少(6.09±2.53比7.30±1.81,P=0.046).结论 Bundle治疗能明显提高重型颅脑疾病VAP患者的好转率,降低病死率,减少其入住ICU时间及住ICU期间的治疗费用.     

机械通气患者贫血的临床观察研究

目的 观察贫血对机械通气患者预后的影响.方法 采用前瞻性研究方法,收集入住重症监护病房(ICU)预计机械通气时间≥72 h,血红蛋白(Hb)浓度≥100 g/L的患者.根据患者机械通气第3日的Hb浓度分为贫血组和非贫血组.比较两组患者1、3、7d血清促红细胞生成素(EPO)、Fe3+、转铁蛋白(TRF)水平,14 d 内人均输血量,3、7、14 d内人均日采血量以及机械通气时间、28 d脱机存活率、住院时间和28 d病死率.结果 共入选40例患者,贫血组18例,非贫血组22例.与非贫血组比较,贫血组患者血清Fe3+较低,血清EPO、TRF较高;贫血组患者14 d内人均输血量(U)较多[4.0(2.0,6.0)比2.0 (0.0,2.0),P＜0.01],ICU病死率较高(44.4％比13.6％,P＜0.05),住院时间(d)较长[35.0( 16.5,51.6)比24.5( 10.0,35.8),P＜ 0.05 ],28 d脱机存活率较低(44.4％比72.7％,P＜ 0.05).而贫血组和非贫血组机械通气时间(d:18.3±10.8比11.6±8.2,P＞0.05)、ICU住院时间[d:16.5(8.0,21.5)比11.0(5.8,18.3),P＞0.05]和住院病死率(61.1％比31.8％,P＞0.05)比较差异无统计学意义.结论 贫血患者机械通气时间及住院时间较长,ICU病死率较高,28 d脱机存活率较低.     

早期综合干预预防机械通气病人重症监护病房获得性衰弱发生的效果

[目的]观察早期综合干预预防机械通气病人重症监护病房(ICU)获得性衰弱发生的效果。[方法]选取2014年4月—2014年6月入住ICU符合纳入标准的病人50例,为对照组;选取2014年7月—2014年9月入住我院ICU符合纳入标准的病人50例,为观察组。对照组病人采取常规的护理措施,观察组病人采取早期综合干预措施,比较两组病人机械通气第3天、第7天ICU获得性衰弱发生的情况。[结果]两组第3天、第7天ICU获得性衰弱的发生情况比较差异有统计学意义(P0.05)。[结论]采取早期综合干预措施能很好地预防机械通气病人ICU获得性衰弱的发生。     

集束化护理对ICU患者肠内营养相关性并发症的预防效果

目的分析集束化护理对ICU患者肠内营养相关性并发症的预防效果。方法回顾性分析某院ICU病房自2015年1月至2017年6月收治的80例患者的临床资料,将其按护理行为分为观察组(集束化护理)与对照组(常规护理),每组40例,比较不同护理干预方式对ICU患者肠内营养相关性并发症的预防效果,比较两组患者腹泻、误吸、堵管、糖代谢异常、上消化道出血等发生率及ICU入住时长与机械通气时长的影响。结果观察组肠内营养支持相关并发症发生率均低于对照组,包括腹泻(12.50% VS 35.00%)、误吸(2.50% VS 15.00%)、堵管(10.00% VS 15.00%)、糖代谢异常(5.00% VS 27.50%)、反流(0.00% VS 2.50%)上消化道出血(0.00% VS 2.50%)等,便秘发生率一致(5.00% VS 5.00%),其中腹泻、误吸、糖代谢异常发生率比较差异有统计学意义(χ~2=5.591、3.913、7.439,皆P0.05);且观察组患者ICU入住时长(14.01±3.28)d、机械通气时长(11.62±4.96)d均较对照组短(18.37±4.22)d、(15.32±5.01)d,比较差异有统计学意义(P0.05)。结论集束化护理不仅对ICU患者肠内营养相关性并发症具有显著预防效果,能减少肠内营养支持相关并发症发生率,对该类患者预后具有积极作用意义。     

全胃肠外营养患者中心静脉导管相关性感染危险因素分析

目的探讨全胃肠外营养患者中心静脉导管相关性感染的危险因素。方法对我科2009年6月至2010年5月使用TPN治疗的86例患者进行回顾性分析。结果中心静脉导管相关性感染发生率为8．1％,其中年龄≥60占57．14％,全胃肠外营养治疗时间≥5d占85．71％,置管时间≥4周占42．86％,使用三通管占57．14％,入住ICU占71．43％。TPN治疗患者发生中心静脉导管相关性感染与无中心静脉导管相关性感染相关因素分析,在年龄≥60岁、全胃肠外营养治疗时间≥3d、置管时间≥4周、使用三通管、人住ICU方面,差异具有统计学意义（P〈0．05）。结论全胃肠外营养患者中心静脉导管相关性感染的发生与多因素有关,包括：年龄、全胃肠外营养治疗时间、置管时间、导管附加装置、人住ICU。     

重症监护病房下呼吸道病原菌的菌群分布及其药敏分析

目的了解重症监护病房（ICU）患者下呼吸道病原菌的菌群分布及药敏情况，为临床应用抗生素提供依据。方法对该院2004年10月至2007年9月369例院内肺部感染者取深部痰液进行培养和药物敏感试验。结果共检出383株病原菌，其中G-杆菌331株，占86．4％；G＋球菌21株，占5．5％；真菌31株，占8．1％。居前两位病原菌是肺炎克雷伯菌122株，铜绿假单胞菌81株。药物敏感试验显示，亚胺培南和丁胺卡那霉素对肺炎克雷伯菌的敏感率最高，分别为100．0％和86．1％；万古霉素对葡萄球菌敏感率最高，达100.0％。结论肺炎克雷伯菌和铜绿假单胞菌是该院ICU的主要病原菌，应合理选用抗生素，减少耐药菌株的产生。     

Myocardial infarction complicating gastrointestinal hemorrhage

OBJECTIVE: To determine the frequency of and risk factors for myocardial infarction (MI) in patients admitted to an intensive-care unit (ICU) with gastrointestinal (GI) hemorrhage and to ascertain the effects on mortality and lengths of stay. MATERIAL AND METHODS: Demographic, laboratory, and outcome data were determined for all patients admitted to a medical ICU with GI hemorrhage between April 1996 and January 1997. Serial creatine kinase with isoenzyme levels and electrocardiograms were interpreted blindly by a senior cardiologist. RESULTS: For 83 consecutive admissions to the ICU because of GI hemorrhage, the patients' mean (+/- standard error) age was 65.0 +/- 1.7 years and APACHE II (acute physiology and chronic health evaluation) score was 15.7 +/- 0.8. In-hospital death occurred in 16 patients (19%). Patients who did not survive had a lower admission systolic blood pressure (99.2 +/- 4.5 versus 115.0 +/- 4.0 mm Hg; P = 0.01) than did those who survived. Eleven of 83 patients (13%) fulfilled both enzymatic and electrocardiographic criteria for MI. Ten patients (12%) had electrocardiographic evidence of myocardial ischemia but did not meet criteria for MI. Patients with MI were older (74.4 +/- 4.0 versus 61.7 +/- 2.0 years; P < 0.05), had a higher acuity of illness (APACHE II score, 21.6 +/- 3.0 versus 14.6 +/- 0.7; P < 0.05), and had more coronary risk factors (2.3 +/- 0.3 versus 1.4 +/- 0.1; P < 0.05) in comparison with those without MI or ischemia. Patients with MI also had longer ICU (8.6 +/- 2.4 versus 3.3 +/- 0.4 days; P < 0.05) and hospital (16.3 +/- 3.4 versus 9.1 +/- 0.8 days; P < 0.05) lengths of stay. Patients older than 65 years had a threefold increased risk (risk ratio, 4.0; 95% confidence interval, 0.9 to 17.4) and those with two or more risk factors for coronary artery disease had a ninefold increased risk of MI (risk ratio, 10.2; 95% confidence interval, 1.4 to 76.1) in comparison with those who were younger or who had fewer coronary risk factors, respectively. MI complicating GI hemorrhage did not significantly affect the risk of in-hospital mortality (risk ratio, 1.5; 95% confidence interval, 0.5 to 4.4). CONCLUSION: MI occurs frequently in patients with GI hemorrhage admitted to an ICU. Age more than 65 years and two or more risk factors for coronary artery disease identify patients who are at greatest risk for occurrence of MI, which is associated with longer ICU and hospital stays.     

2012—2016年医院感染现患率调查

  目的  了解医院感染的实际情况及变化趋势, 以有效预防与控制医院感染。  方法  采用横断面调查方法, 调查北京协和医院2012年12月12日、2013年12月4日、2014年5月21日、2015年5月20日、2016年5月11日所有住院患者, 对5年医院感染相关资料进行统计分析。  结果  5年医院感染现患率分别为6.67%、6.33%、5.66%、5.16%、4.65%, 呈逐年下降趋势。重症监护病房医院感染现患率最高。感染部位以下呼吸道感染居首位, 占40.88%;其次分别为泌尿系统感染(10.81%)和手术部位感染(9.97%)。医院感染病原体以革兰阴性菌为主, 占63.16%;多重耐药菌株占检出病原菌的32.85%。  结论  医院感染现患率逐年下降, 体现医院感染管理与控制效果显著, 各科室和感染部位情况提示重症监护病房、下呼吸道感染仍是医院感染控制的重点。医院感染近年来面临多重耐药菌的威胁, 在有力规范抗菌药物合理应用的同时, 应加强多重耐药菌定植和感染患者的接触隔离。     

ICU之院内感染相关因素调查研究

目的 通过对ICU患者细菌培养标本的分析,了解重症监护室院内感染的相关因素,减少患者院内感染的发生率,提高患者的存活率及存活时间.方法 对我院2008年1月～2009年12月期间ICU内患者的临床及实验室资料进行了回顾性的分析及统计学处理.结果 287例ICU内患者的送检标本中,细菌培养后可见病原菌者186例,阳性率为64.8%,感染部位以呼吸道为主占78.9%（154/195）,其次为刀口分泌物及脑脊液等 检出菌以G-杆菌为主占81.2%,主要为铜绿假单胞菌及鲍曼氏不动杆菌 G＋球菌占17.7%,主要为葡萄球菌.结伦 ICU院内感染的发生率与患者的与患者的体质、住院时间、入侵病原菌,损伤性技术操作等密切相关.科学使用抗生素、缩短住院时间、加强护理质量对控制院内感染将起重要作用.     

Factors associated with relative rates of antibiotic resistance in Pseudomonas aeruginosa isolates tested in clinical laboratories in the United States from 1999 to 2002

For the period from 1999 to 2002 in the United States, the in vitro susceptibilities of 52,637 Pseudomonas aeruginosa isolates to 10 antimicrobial agents were evaluated. The isolates were from 29 laboratories, 11 of which participated in The Surveillance Network for four consecutive years. Isolates were collected from adult patients (> or =18 years of age) in intensive care units (ICU), non-ICU inpatients, nursing home patients, and outpatients; data were analyzed to evaluate factors, such as year of isolation, patient age group, isolate specimen source, and patient type (hospitalized patients [ICU, non-ICU, or nursing home] or outpatients). Rates of resistance for the 4-year period were highest for isolates from patients in ICU and 18- to 39-year-old patients and for isolates from the lower respiratory tract. Resistance decreased with age. Resistance was lowest in isolates from outpatients, in isolates from > or =70-year-old patients, and from specimens from the upper respiratory tract. Multidrug resistance (MDR) (resistance to three or more antimicrobial agents) accounted for 24.9% of all isolates. The MDR rate was highest in isolates from patients in nursing homes (29.9%) and ICU (29.5%).     

Acute respiratory distress syndrome in trauma patients: ICU mortality and prediction factors

OBJECTIVES: To study the factors that influence the intensive care unit (ICU) mortality of trauma patients who develop acute respiratory distress syndrome (ARDS) and to evaluate determinants of length of ICU stay among these patients. DESIGN: Study on a prospective cohort of 59 trauma patients that developed ARDS. SETTING: ICU of a referral trauma center. Fifty-nine patients were included during the study period from 1994 to 1997. METHODS: The dependent variables studied were the mortality and length of ICU stay. The main independent variables studied included the general severity score APACHE III, the revised trauma and injury severity scores (RTS, ISS), emergency treatment measures, the gas exchange index (PaO2/FIO2) recorded after the onset of ARDS and the development of multiple system organ failure (MSOF). Univariate and multivariate analyses were performed. RESULTS: The mean age of patients was 42.1 +/- 16.7 years, 49 patients (83 %) were male, the mean APACHE III score was 52.7 +/- 33.7 points, the ISS 28.5 +/- 11.4 points and the RTS 8.9 +/- 2.5 points. ICU length of stay was 28.5 +/- 24.5 days and the mortality rate 31.7 % (19 deaths). Mortality was associated with the following: PaO2/FIO2 ratio on the 3rd, 5th and 7th days post-ARDS; high volume of crystalloid/colloid infusion during resuscitation; the APACHE III score; and the development of MSOF According to the multivariate analysis, the mortality of these patients was correlated with the PaO2/FIO2 ratio on the 3rd day of ARDS, the APACHE III score and the development of MSOF. This analysis also showed days on mechanical ventilation to be the only variable that predicted ICU length of stay. CONCLUSIONS: The ICU mortality of trauma patients with ARDS is related to the APACHE III score, the gas exchange evolution as measured by the PaO2/FIO2 on the 3rd day and the progressive complications indicated by the onset of MSOF. The length of ICU stay of these patients is related to the number of days on mechanical ventilation.     

ICU医院感染的临床分析与护理对策

目的：探讨ICU医院感染的因素．以期采取有针对性的护理干预措施。方法：回顾调查ICU医院感染37例的临床资料。结果：37例中感染61例次，以呼吸道感染为主．检出致病菌86株，G^ 菌占37．21％，G^-占46．67％，真菌占19．77％，耐药金黄色葡萄球菌、铜绿假单胞菌及真菌感染比例增大。结论：为了有效地降低医院感染率，必须采取有效的护理干预措施。     

Mechanical ventilation of patients hospitalized in medical wards vs the intensive care unit--an observational, comparative study

BACKGROUND: In some hospitals, patients are mechanically ventilated on the wards in addition to the intensive care unit (ICU) because of the shortage of ICU beds. OBJECTIVE: The aim of the study was to compare the outcome and ventilatory management of medical patients mechanically ventilated on the medical wards and in the ICU. DESIGN: This was a prospective, observational, noninterventional study over a 6-month period. SETTING: The study was conducted in internal medicine wards and the ICU of a 500-bed community university-affiliated hospital. PATIENTS: Ninety-nine mechanically ventilated medical patients in the ICU or on the medical wards because of shortage of ICU beds were included in the study. RESULTS: Baseline characteristics of the patients ventilated in the ICU (group 1) and in the medical wards (group 2) were collected. Thirty-four patients were ventilated in the ICU and 65 in the wards during the study period. In-hospital survival rate in group 1 was 38% vs 20% in group 2 (P < .05). The Acute Physiologic and Chronic Health Evaluation (APACHE) II score in group 1 was 24 +/- 7 vs 27 +/- 7 in group 2 (P < .05). Other prognostic factors were similar. The age of the survivors in the 2 groups was similar: 57 +/- 25 years in group 1 vs 69 +/- 13 years in group 2 (P = NS). Mean number of ventilatory changes in group 1 was 7.5 +/- 1.4 per day per patient, whereas it was 1.3 +/- 1.0 in group 2 (P < .001). The number of arterial blood gas analyses in group 1 was 7.7 +/- 1.2 per day per patient compared with 2.3 +/- 1.3 in group 2 (P < .001). Twenty percent (20%) of the patients in group 1 had endotracheal tube-related inadvertent events compared with 62% of the patients in group 2 (P < .05). CONCLUSIONS: We conclude that in medical patients requiring mechanical ventilation, there is a higher in-hospital survival rate in ICU-ventilated patients as compared with ventilated patients managed on the medical wards. In addition, ICU provides a better monitoring associated with less endotracheal tube-related complications and more active ventilatory management.     

Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization

OBJECTIVE: To evaluate trends in mortality and related factors among trauma patients who developed acute respiratory distress syndrome (ARDS). STUDY: Observational study based on data prospectively gathered in computerized trauma registry. SETTING: Trauma intensive care unit (ICU) of 48 beds in level I trauma center. PATIENTS: All trauma patients with ARDS admitted during 1985-87 (486, group 1 [G1]) and 1993-95 (552, group 2[G2]). METHODS: ARDS was defined by American-European Consensus Conference criteria and the need for 48 h or more on mechanical ventilation with FIO2 greater than 0.50 and PEEP of more than 5 cmH2O. Demographics, severity score, injury-admission delay time, first 24-h transfusion and septic and organ system failure complications were independent variables. ICU mortality was the dependent variable. ICU length of stay (LOS) and life support techniques were considered. Respiratory and renal support strategies were different in the two time periods. RESULTS: Mortality decreased over the period (G1: 29.2% vs G2: 21.4%, p < 0.04), in patients aged both over and under 65 years. Multivariate analysis showed mortality was related to age, severity and time period (G1 1.68-fold that in G2) and that the greater G1 mortality was related to more renal failure and hematologic failure/dysfunction. ICU LOS decreased from 31.7+/-26.7 days (G1) to 27.3+/-22 days (G2) (p < 0.003). CONCLUSIONS: Mortality among trauma patients with ARDS declined over the 8 years studied and was associated with less organ failure. This reduction was probably the result of new approaches to mechanical ventilation, renal failure replacement and vasoactive drug therapy.