Abstract: Objective To analyze the risk factors and therapy strategies of acute pulmonary edema (APE) in critically ill patients with multiple trauma. Methods We conducted a retrospective analysis with the clinical date of all the critically ill patients with multiple trauma treated in General ICU from Jan. 2009 to Jan. 2012.We compared the clinical characteristics of the patients with or without onset of APE. The patients with APE were divided into young group (≤ 55 yr.) or elderly group (>55 yr.),then the clinical data were analyzed between the two groups, includingthe level of hemoglobin (Hb), mean arterial pressure (MAP), central venous pressure (CVP), serum albumin (Alb), as well as complications, liquid balance during 1 week, 3 d, 1 d before the onset of APE. Results Among the 284 patients with multiple trauma, APE was detected in 47 patients (16.5%) for 68 times,29 (61.7%) in young group and 18 (38.3%) in elderly group. The ratio of acute renal failure (ARF) and systematic infection were significantly higher in the patients with APE (P<0.05). Hb,MAP,CVP,Alb and the ratio of ARF, severe infection, extremity lost were not statistically different (P>0.05) between young and elderly group, while the ratio of primary heart disease was significantly higher in elderly group (P<0.05). The net balance of liquid during 1 week, 3 d and 1 d before the onset of APE was significantly higher in young group (P<0.05). Conclusion Mutiple Trauma patients with ARFare prone to encounter APE on the exist of infection and overburden of liquid; young patients tend to develop APE followed by liquid overburden,while elderly patients tend to develop APE because of poor primary heart condition even with more cautious fluid infusion.