The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation

Villar, Jesús; Blanco, Jesús; Añón, J.M.; Santos-Bouza, Antonio; Blanch, Lluís; Ambrós, Alfonso; Gandía, Francisco; Carriedo, Demetrio; Mosteiro, Fernando; Basaldúa, Santiago; Fernandez, R.; Kacmarek, Robert M.

doi:10.1007/s00134-011-2380-4

Cited by 500 publications

(430 citation statements)

References 42 publications

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“…The discrepancy of basic diseases between the ARDS and non‐ARDS group might limit the clinical application of this study. In addition, the mortality of ARDS group in this study seems to be higher than other reported studies 1, 2, 3. This is probably due to the heterogeneity of different study populations.…”

Section: Discussioncontrasting

confidence: 60%

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Diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with acute respiratory distress syndrome

Lin

Zhang

Wang

et al. 2017

Clinical Laboratory Analysis

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BackgroundAcute respiratory distress syndrome (ARDS) is a critical condition characterized by bilateral pulmonary infiltrates and severe hypoxemia. This study aimed to evaluate the diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with ARDS.MethodsIn this retrospective observational study, 83 patients with ARDS and 129 non‐ARDS patients on ICU admission were enrolled. The differences in serum CC16 and other laboratory indicators between two groups were analyzed. The sensitivity, specificity, positive and negative predictive values, and accuracy of CC16 as a diagnostic marker on ICU admission were determined by receiver operating characteristic (ROC) curve analysis. The correlation between serum CC16 levels and the severity of ARDS as quantified by PaO2/FiO2 ratio were further assessed. CC16 levels were compared between survivors and non‐survivors. The relationships between CC16 levels and duration of ICU and hospitalization were evaluated.ResultsThe serum CC16 levels in ARDS patients were significantly higher than that in non‐ARDS patients (54.44±19.62 vs 24.13±12.32 ng/mL, P=.001). ROC analysis showed that the sensitivity, specificity, positive predictive value, and negative predictive value were 90.4%, 79.8%, 74.2%, and 92.8%, respectively, when the cut‐off value was set at 33.3 ng/mL. CC16 levels were correlated with the severity of ARDS. The serum CC16 levels were significantly greater in non‐survivors than in survivors from the ARDS group. CC16 levels were associated with ICU stay but not hospital stay.Conclusions CC16 may serve as a diagnostic and stratification marker for ARDS. However, it provided limited prognostic information for ARDS.

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Section: Discussioncontrasting

confidence: 60%

“…Acute respiratory distress syndrome (ARDS), characterized by permeability pulmonary edema and refractory hypoxemia, has an enormous effect on both morbidity and mortality 1, 2, 3. The Berlin definition is widely accepted for diagnosing ARDS, and the diagnosis is predominantly based on oxygenation index and chest X‐ray 4.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with acute respiratory distress syndrome

Lin

Zhang

Wang

et al. 2017

Clinical Laboratory Analysis

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“…According to medical history, bronchoalveolar lavage fluid cytology, and chest computed tomography (CT) scan patterns, four etiological categories were identified in this group of patients: immune, drug-induced, malignant, and idiopathic [6]. The overall ICU mortality rate was higher in patients lacking common risk factors as compared to their counterparts, even after adjustment for potential confounding factors [6].It is already well known that ventilator-induced lung injury contributes to ARDS-associated mortality [2,3]. Recently, some biological markers have been proposed as potential biomarkers of ARDS, such as the soluble form of the receptor for advanced glycation end-products (sRAGE).…”

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confidence: 98%

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Despite the attempt to homogenize its definition following the publication of the Berlin criteria, there is still a high heterogeneity in the epidemiology of ARDS across the world [3].

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Focus on ARDS

2017

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Since 1967, when first described, ARDS has been widely recognized as a major health problem worldwide, carrying a high morbidity and mortality [1][2][3]. This focus editorial summarizes recent advances about the incidence, pathophysiology, right ventricular dysfunction, and mortality of ARDS.Despite the attempt to homogenize its definition following the publication of the Berlin criteria, there is still a high heterogeneity in the epidemiology of ARDS across the world [3]. Indeed, estimates of the incidence of ARDS are highly variable, ranging from less than 2 to more than 70 cases per 100,000 person-years, with the most recent study on the topic suggesting a higher incidence in Europe, North America, and Oceania compared to South America, Asia, and Africa [2,3]. However, it is important to emphasize that this scenario could only reflect the under-recognition of this syndrome [3]. Recent reports suggest a progressive decline of the incidence of ARDS. In a study conducted in Rochester, cases fell by half between 2001 and 2008 while mortality remained stable [4]. Nearly all of the reduction in the incidence was observed in hospital-acquired ARDS, suggesting that ARDS could be prevented through strategies addressing its related risk factors [4,5]. However, in some instances, patients meeting the Berlin criteria for ARDS lack exposure to common risk factors [6]. It was recently reported that the prevalence of patients with ARDS but without common risk factors was as high as 7.5% [6]. According to medical history, bronchoalveolar lavage fluid cytology, and chest computed tomography (CT) scan patterns, four etiological categories were identified in this group of patients: immune, drug-induced, malignant, and idiopathic [6]. The overall ICU mortality rate was higher in patients lacking common risk factors as compared to their counterparts, even after adjustment for potential confounding factors [6].It is already well known that ventilator-induced lung injury contributes to ARDS-associated mortality [2,3]. Recently, some biological markers have been proposed as potential biomarkers of ARDS, such as the soluble form of the receptor for advanced glycation end-products (sRAGE). This biomarker is a transmembrane receptor that can bind multiple ligands resulting in intracellular signaling, leading to activation of the proinflammatory transcription factor nuclear factor κB [7]. Plasma levels of sRAGE could change according to ventilator settings in ARDS patients, as recently suggested by a study describing a significant decrease of sRAGE 1 h after a recruitment maneuver followed by an increase toward baseline values 4 h after the maneuver [7]. It has also been shown that sRAGE is higher in non-survivors than survivors in early pediatric ARDS and strongly correlated with number of non-pulmonary organ failures [8]. Other biomarkers of endothelial injury are also investigated in ARDS patients. Higher levels of circulating endothelial cells were found in the blood of patients with moderate-to-severe ARDS as compared to those with...

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Acute Respiratory Distress Syndrome

Force

Ranieri

Rubenfeld

et al. 2012

JAMA

5,762

3,955

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Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in atrisk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care. Definition and epidemiologySince its first description by ASHBAUGH et al. [1] in 1967, the acute respiratory distress syndrome (ARDS) has been widely recognised as a major clinical problem worldwide, carrying a high morbidity and mortality burden [2][3][4]. Although the recent Berlin definition [5] is probably much better than previous ones, there is still a high variability in both epidemiology and clinical outcomes in diverse healthcare settings [4]. In fact, the incidence of ARDS ranges from 1.5 cases per 100 000 [2] to nearly 79 cases per 100 000 [3], with European countries reporting a lower incidence than USA [6]. Moreover, studies from Brazil reported incidence rates ranging from 1.8 to 31 per 100 000 [7,8].Although the overall survival rate is improving [9, 10], there is a notable difference when considering in-hospital mortality over several observational studies [2][3][4][8][9][10][11]. This may be explained by differences in risk factors, availability of diagnostics, ability to recognise ARDS and some selection biases affecting clinical trials [12]. Recently, a large international observational study (the LUNG SAFE trial) evaluated the incidence of ARDS across 459 intensive care units (ICUs) in 50 countries [13]. To assess the clinical recognition of ARDS according to the latest definition, any patient inclusion into the trial was made through a computer algorithm following the Berlin criteria [5], and then compared to the diagnosis made by the attending physicians. Among 4499 patients who developed acute hypoxaemic respiratory failure, ARDS occurred in 10.4% of t...

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The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation

Cited by 500 publications

References 42 publications

Diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with acute respiratory distress syndrome

Diagnostic and prognostic values of Club cell protein 16 (CC16) in critical care patients with acute respiratory distress syndrome

Focus on ARDS

Acute Respiratory Distress Syndrome

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