Epidemiology of Acute Lung Injury and ARDS

Hudson, Leonard D.; Steinberg, Kenneth P.

doi:10.1378/chest.116.suppl_1.74s-a

Cited by 178 publications

(113 citation statements)

References 33 publications

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“…Our study, which focused on risk factors present in the most proximal phase of the hospitalization, confirms the notion that severity of illness and a pulmonary source of infection are risk factors for the development of ARDS (3,10,14,(41)(42), while diabetes is protective (19). As constituent variables of the LIPS, these risk factors are incorporated in the clinical risk prediction score to identify patients at high risk of ARDS development.…”

Section: Discussionsupporting

confidence: 79%

“…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).…”

Section: Risk Factors For Ards Developmentmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Mikkelsen¹,

Shah²,

Meyer³

et al. 2013

Shock

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Section: Discussionsupporting

confidence: 79%

Section: Risk Factors For Ards Developmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Mikkelsen¹,

Shah²,

Meyer³

et al. 2013

Shock

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“…Both ARDS and its less severe counterpart, acute lung injury (ALI), are characterized by parenchymal inflammation, diffuse alveolar damage and impaired gas exchange leading to respiratory failure. 7 The diagnostic criteria for ARDS/ALI are based on the American-European Consensus Conference (AECC) on ARDS published in 1994. 8 For ARDS, criteria include hypoxia, partial arterial content of oxygen (PaO 2 ) to fraction of inspired oxygen (FiO 2 ) ratio of p200, and evidence of bilateral pulmonary infiltrates on chest imaging.…”

Section: Introductionmentioning

confidence: 99%

Acute respiratory distress syndrome and acute lung injury in patients with vertebral column fracture(s) and spinal cord injury: a nationwide inpatient sample study

et al. 2013

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Study design: Retrospective Nationwide Inpatient Sample (NIS) study. Objectives: To determine national trends in prevalence, risk factors and mortality for vertebral column fracture (VCF) and spinal cord injury (SCI) patients with and without acute respiratory distress syndrome/acute lung injury (ARDS/ALI). Setting: United States of America, 1988 to 2008. Methods: The NIS was utilized to select 284 612 admissions for VCF with and without acute SCI from 1988 to 2008 based on ICD-9-CM. The data were stratified for in-hospital complications of ARDS/ALI. Results: Patients with SCI were more likely to develop ARDS/ALI compared with those without (odds ratio (OR): 4.9, 95% confidence interval (CI) 4.7-5.2, Po0.001). Compared with patients with lumbar fractures, those with cervical, thoracic and sacral fractures were more likely to develop ARDS/ALI (Po0.001). ARDS/ALI was statistically more prevalent (Po0.01) in VCF/SCI patients with epilepsy, sepsis, cardiac arrest, congestive heart failure (CHF), hypertension, chronic obstructive pulmonary disease and metabolic disorders. Patients with female gender, surgery at rural practice setting, and coronary artery disease and diabetes were less likely to develop ARDS/ALI (Po0.001). VCF/SCI patients who developed ARDS/ALI were more likely to die in-hospital than those without ARDS/ALI (OR 6.5, 95% CI 6.0-7.1, Po0.001). Predictors of in-hospital mortality after VCF/SCI include: older age, male sex, epilepsy, sepsis, hypertension, CHF, chronic obstructive pulmonary disease and liver disease. Patients who developed ARDS/ALI stayed a mean of 25 hospital days (30-440 days) while patients without ARDS/ALI stayed a mean of 6 days (7-868 days, Po0.001). Conclusion: Our analysis demonstrates that SCI patients are more at risk for ARDS/ALI, which carries a significantly higher risk of mortality.

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“…ALI results from a variety of insults as diverse as meconium aspiration in newborns, hydrochloric acid reflux, sepsis, and ventilator trauma. In turn, injury predisposes the patient to acute (or adult) respiratory distress syndrome (ARDS) (1)(2)(3)(4). Pulmonary surfactant replacement, now a mainstay in the treatment of respiratory distress syndrome in premature infants, has not enjoyed comparable success in treating ARDS (5)(6)(7).…”

mentioning

confidence: 99%

Polyethylene Glycol-Surfactant for Lavage Lung Injury in Rats

Dehority

Clements

et al. 2005

Pediatr Res

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Addition of ionic and nonionic water-soluble polymers to pulmonary surfactants in the presence of inactivating substances prevents surfactant inactivation in vitro and improves lung function in several models of lung injury. However, a recent report found opposite effects when surfactant plus polyethylene glycol (PEG) was used to treat lung injury caused by saline lung lavage. Therefore, we examined the reasons why the polymer effect is less evident in the saline lung lavage lung injury model. We treated rats with lavage lung injury with a commercial lung surfactant extract derived from bovine lung (Survanta) with or without addition of PEG. Groups treated with Survanta ϩ PEG had significantly higher static post mortem lung volumes than groups treated with Survanta. However, groups treated with Survanta ϩ PEG had more tracheal fluid and no significant benefit in arterial oxygenation compared with the group treated with Survanta, despite our use of measures to reduce pulmonary edema. Measurements after intravascular injections of 125 I-labeled albumin confirmed that addition of PEG increased extravascular lung water and that this effect is mitigated by furosemide. We conclude that surfactant ϩ PEG mixtures are less effective in lavage injury than in other forms of lung injury because of increased extravascular lung water. ALI results from a variety of insults as diverse as meconium aspiration in newborns, hydrochloric acid reflux, sepsis, and ventilator trauma. In turn, injury predisposes the patient to acute (or adult) respiratory distress syndrome (ARDS) (1-4). Pulmonary surfactant replacement, now a mainstay in the treatment of respiratory distress syndrome in premature infants, has not enjoyed comparable success in treating ARDS (5-7). Inadequate dosage or distribution, and inactivation of surfactant have been postulated for its poor performance in treating these injuries (8 -11).Multiple reports indicate improved surfactant function when polymers such as dextrans, PEG, and hyaluronan are added to surfactant preparations in vitro (12-15). Animals with ALI have improved lung function when treated with surfactant polymer mixtures versus surfactant alone. found that adult rats receiving surfactant ϩ PEG, dextran, or hyaluronan mixtures have better gas exchange, pulmonary mechanics, and histologic appearance of the lungs when compared with rats treated with Survanta (beractant) alone after HCl-, meconium-, and endotoxin-induced lung injuries. Kobayashi et al. (19,20) have shown that addition of dextran to surfactant improves responses in two additional lung injury models (albumin inhibition in immature rabbits and acid milk aspiration in rats).The specific model used to induce ALI, however, may affect treatment responses to surfactant and surfactant ϩ PEG, as different models of lung injury produce different alveolar environments. A lavage model of lung injury, for example, removes variable amounts of alveolar surfactant (21), whereas a meconium model of lung injury inactivates but does not remove surfactant. P...

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Epidemiology of Acute Lung Injury and ARDS

Cited by 178 publications

References 33 publications

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

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

Acute respiratory distress syndrome and acute lung injury in patients with vertebral column fracture(s) and spinal cord injury: a nationwide inpatient sample study

Polyethylene Glycol-Surfactant for Lavage Lung Injury in Rats

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