T he fi nding of acute hypoxemia and bilateral lung infi ltrates on frontal chest radiograph is common in the ICU setting, and differentiation between cardiogenic pulmonary edema (CPE) and noncardiogenic pulmonary edema (acute lung injury [ALI]) is diffi cult and challenging in the early stages of illness. 1,2 Left atrial hypertension (LAH) as a principal cause of acute pulmonary edema must be excluded before making a diagnosis of ALI and its more severe form, ARDS. 3 Conversely, to exclude ALI, one needs not only the evidence of LAH but also the absence of signifi cant ALI risk factors. Traditionally, a pulmonary artery occlusion pressure (PAOP) . 18 mm Hg has been used as a surrogate marker of LAH. It is rarely used in current clinical practice because it is invasive, the effi cacy of pulmonary artery catheter-guided therapy in critically ill patients has not been proven, 4 and some studies have suggested increased morbidity and mortality associated with its use. Abbreviations: AECC 5 American European Consensus Conference; ALI 5 acute lung injury; AUC 5 area under curve; BNP 5 brain natriuretic peptide; CAD 5 coronary artery disease; CPE 5 cardiogenic pulmonary edema; CVP 5 central venous pressure; DC 5 development cohort; E/E 9 5 ratio of mitral peak velocity of early fi lling (E) to early diastolic mitral annular velocity (E 9 ); HL 5 Hosmer-Lemeshow test; IQR 5 interquartile range; LAH 5 left atrial hypertension; LBBB 5 left bundle branch block; PAOP 5 pulmonary occlusion pressure; Sp o 2 5 peripheral oxygen saturation; VC 5 validation cohort
Drugs are important risk factors for ALI, and recognizing them as such may have important implications for early identification of patients at risk, discontinuation of the offending agent, and prognosis.
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