Adult Respiratory Distress Syndrome: Risk with Common Predispositions

Abstract

A 1-year survey of patients in three hospitals identified 936 patients who had one predisposition and 57 who had several predispositions to the adult respiratory distress syndrome. From the total predisposed population of 993 patients, 68 subsequently developed the syndrome. An additional 20 patients developed the syndrome from causes other than eight identified predispositions, to bring the total of patients studied to 88. A highly significant difference (p less than 0.0001) was found in the incidence rates of the syndrome between patients with one and several predispositions (5.8 versus 24.6 per 100 patients). Within 72 hours of onset of predisposition, 89.5% of patients who developed the syndrome had been intubated and placed on mechanical ventilation. Fifty-seven of the 88 patients (64.8%) with the syndrome died. By the 14th day 90% of deaths had occurred. There were no age- or sex-specific differences in either incidence or mortality rates. Case fatality rates of the syndrome were high in all predisposed groups.

Complete reversal of acid-induced acute lung injury by blocking of platelet-neutrophil aggregation

“…These observations indicate that platelet-neutrophil interactions are critical to the development of ALI, to which they contribute by enhancing their respective activations, which trigger the production of TXA 2 and other inflammatory mediators. Pulmonary aspiration of gastric content induces ALI in 26%-36% of all cases and is associated with a high mortality (34,35). Aspiration of acid may damage the alveolar-capillary membrane and induce a release of inflammatory mediators, inflammatory cells, expression of adhesion molecules, and enzymes, including TNF-α, IL-8, cyclooxygenase and lipoxygenase products, and reactive oxygen species (4).…”

Thoracotomy procedures effect cytokine levels after thoracoabdominal esophagectomy

“…For instance, up to 30% of the patients after thoracoabdominal esophagectomy develop pulmonary complications such as ALI or even ARDS (17). Although a variety of insults may lead to ALI and ARDS, a common pathway may probably result in lung damage (18)(19)(20).…”

The Epidemiology of Acute Respiratory Distress Syndrome in Patients Presenting to the Emergency Department With Severe Sepsis

“…Based on clinical plausibility and/or a relationship with the development of ARDS, we examined the following variables as factors which may be associated with ARDS development: age, gender, race, comorbid conditions (e.g., diabetes mellitus), ED therapy (e.g., time to antibiotics, blood transfusion, fluid resuscitation), cause of ALI (pulmonary vs. non-pulmonary), whether the infection was microbiologically-proven, severity of illness (e.g., APACHE II, shock), and the LIPS (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). The LIPS incorporates predisposing conditions associated with ARDS development (e.g., shock, aspiration) and risk modifiers (e.g., alcohol abuse as risk factor, diabetes as protective factor) (7).…”

“…The Lung Injury Prediction score (LIPS), a recently validated clinical prediction score to identify patients at-risk for development of ALI, has not been applied to the severe sepsis population directly (7). Further, while prior studies have examined the epidemiology of ARDS in severe sepsis (2)(3)(4)(8)(9)(10)(11)(12)(13)(14)(15), predominantly from the ICU perspective, to our knowledge, no study has focused their examination on the epidemiology of ARDS in severe sepsis from the earliest presentation to the health care system, the Emergency Department (ED).…”