The Prevalence and Impact of Mortality of the Acute Respiratory Distress Syndrome on Admissions of Patients With Ischemic Stroke in the United States

Rincón, Fred; Maltenfort, Mitchell; Dey, Saugat; Ghosh, Sayantani; Vibbert, Matthew; Urtecho, Jacqueline; Jallo, Jack; Ratliff, John K.; McBride, J.W.; Bell, Rodney

doi:10.1177/0885066613491919

Cited by 34 publications

(26 citation statements)

References 37 publications

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“…ARDS was also associated with a significant increase in mortality, and it prolonged the duration of mechanical ventilation and the length of ICU stay. Similarly, in previous reports, ARDS has been identified as a major contributor to the morbidity and mortality of patients with brain injuries [2,3,5,15,17,18,30]. ARDS also worsens longterm neurologic outcome [1,2,3,32], and is associated with longer ICU and hospital length of stay [5,29].…”

Section: Discussionsupporting

confidence: 57%

“…Several studies have shown ARDS to be a consequence of underlying illness and predisposing conditions such as young age, male gender, ethnicity, history of chronic arterial hypertension, diabetes, chronic obstructive pulmonary disease, development of sepsis, cardiovascular, renal and haematological dysfunctions [17,30,31]. In addition, other interventions such as exposure to blood products may potentiate pulmonary injury in a susceptible host or lead directly to transfusion-related ARDS.…”

Section: Discussionmentioning

confidence: 99%

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Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Tejerina

Pelosi

Muriel

et al. 2017

Journal of Critical Care

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a b s t r a c t a r t i c l e i n f oPurpose: In neurologically critically ill patients with mechanical ventilation (MV), the development of acute respiratory distress syndrome (ARDS) is a major contributor to morbidity and mortality, but the role of ventilatory management has been scarcely evaluated. We evaluate the association of tidal volume, level of PEEP and driving pressure with the development of ARDS in a population of patients with brain injury. Materials and methods: We performed a secondary analysis of a prospective, observational study on mechanical ventilation. Results: We included 986 patients mechanically ventilated due to an acute brain injury (hemorrhagic stroke, ischemic stroke or brain trauma). Incidence of ARDS in this cohort was 3%. Multivariate analysis suggested that driving pressure could be associated with the development of ARDS (odds ratio for unit increment of driving For personal use only. No other uses without permission. Copyright ©2017. Elsevier Inc. All rights reserved. pressure 1.12; confidence interval for 95%: 1.01 to 1.23) whereas we did not observe association for tidal volume (in ml per kg of predicted body weight) or level of PEEP. ARDS was associated with an increase in mortality, longer duration of mechanical ventilation, and longer ICU length of stay. Conclusions: In a cohort of brain-injured patients the development of ARDS was not common. Driving pressure was associated with the development of this disease.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Tejerina

Pelosi

Muriel

et al. 2017

Journal of Critical Care

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“…Several studies have addressed these factors with variable results. [11415161718192021222324252627] The aims of this study were to determine the role of demographic data such as age, gender, and race on the outcome and also to study other variables that have not been previously addressed such as pre-ICU patient location and type of ICU.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the risk of death from ARDS associated with sepsis and burn were higher than with trauma or neurological complications. [252627]…”

Section: Discussionmentioning

confidence: 99%

The effect of demographics and patient location on the outcome of patients with acute respiratory distress syndrome

et al. 2017

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OBJECTIVE:Outcome of acute respiratory distress syndrome (ARDS) in relation to age, gender, race, pre-Intensive Care Unit (ICU) location, and type of ICU.METHODS:Retrospective cohort study of patients enrolled in the ARDS network randomized controlled trials.RESULTS:A total of 2914 patients were included in these trials. Outcomes were adjusted to baseline covariates including APACHE III score, vasopressor use, cause of lung injury, lung injury score, diabetes, cancer status, body mass index, and study ID. Older patients had significantly higher mortality at both 28- and 60-day (odds ratio [OR] 2.59 [95% confidence interval [CI]: 2.12–3.18] P < 0.001 and 2.79, 95% CI: 2.29–3.39, P < 0.001, respectively); less ICU and ventilator free days (relative risk [RR] 0.92, 95% CI: 0.87–0.96, P < 0.001 and 0.92, 95% CI: 0.88–0.96, P < 0.001, respectively). For preadmission location, the 28- and 60-day mortality were lower if the patient was admitted from the operating room (OR)/recovery room (OR 0.65, 95% CI: 0.44–0.95, P = 0.026; and OR = 0.66, 95% CI: 0.46–0.95, P = 0.025, respectively) or emergency department (OR = 0.78, 95% CI: 0.61–0.99, P = 0.039; and OR = 0.71, 95% CI: 0.56–0.89, P = 0.004, respectively), but no statistical differences in ICU and ventilator free days between different preadmission locations. Races other than white and black had a statistically higher mortality (28- and 60-day mortality: OR = 1.47, 95% CI: 1.09–1.98, P = 0.011; and OR 1.53, 95% CI: 1.15–2.04, P = 0.004, respectively). Between whites and blacks, females and males there were no statistically significant differences in all outcomes.CONCLUSION:Older patients and races other than blacks and whites have higher mortality associated with ARDS. Mortality is affected by patients preadmission location. There are no differences in outcome in relation to the type of ICU, gender, or between blacks and whites.

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“…The definition for ARDS using administrative data we used has been widely utilized in many other studies(Reynolds et al, 1998; Rincon et al, 2014, 2012; Rush et al, 2016; Veeravagu et al, 2014). Our definition of ARDS was consistent with previous authors and included (1) International Classification of Diseases, Ninth Revision (ICD −9) codes for acute respiratory failure following trauma and surgery (518.51); (2) other pulmonary insufficiency, not elsewhere classified, following trauma and surgery (518.52); (3) acute and chronic respiratory failure following trauma and surgery (518.53); (4) acute respiratory failure (518.81); (5) and other pulmonary insufficiency, not elsewhere classified (518.82)(Reynolds et al, 1998; Rincon et al, 2014; Veeravagu et al, 2014). Unfortunately, due to the lack of detailed granular variables in the NIS dataset we were unable to classify patients according to the Berlin definition of ARDS(Ferguson et al, 2012).…”

Section: Methodsmentioning

confidence: 99%

Association between chronic exposure to air pollution and mortality in the acute respiratory distress syndrome

Rush

McDermid

Celi

et al. 2017

Environmental Pollution

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The impact of chronic exposure to air pollution and outcomes in the acute respiratory distress syndrome (ARDS) is unknown. The Nationwide Inpatient Sample (NIS) from 2011 was utilized for this analysis. The NIS is a national database that captures 20% of all US in-patient hospitalizations from 47 states. Patients with ARDS who underwent mechanical ventilation from the highest 15 ozone pollution cities were compared with the rest of the country. Secondary analyses assessed outcomes of ARDS patients for ozone pollution and particulate matter pollution on a continuous scale by county of residence. A total of 8,023,590 hospital admissions from the 2011 NIS sample were analyzed. There were 93,950 patients who underwent mechanical ventilation for ARDS included in the study. Patients treated in high ozone regions had significantly higher unadjusted hospital mortality (34.9% versus 30.8%, p < 0.01) than patients in cities with control levels of ozone. After controlling for all variables in the model, treatment in a hospital located in a high ozone pollution area was associated with an increased odds of in-hospital mortality (OR 1.11, 95% CI 1.08–1.15, p < 0.01). After adjustment for all variables in the model, for each increase in ozone exposure by 0.01 ppm the OR for death was 1.07 (95% CI 1.06–1.08, p < 0.01). Similarly, for each increase in particulate matter exposure by 10 μg/m3, the OR for death was 1.08 (95% CI 1.02–1.16, p < 0.01). Chronic exposure to both ozone and particulate matter pollution is associated with higher rates of mortality in ARDS. These preliminary findings need to be confirmed by further detailed studies.

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The Prevalence and Impact of Mortality of the Acute Respiratory Distress Syndrome on Admissions of Patients With Ischemic Stroke in the United States

Abstract: Our analysis demonstrates that ARDS is rare after AIS. Despite an overall significant reduction in mortality after AIS, ARDS carries a higher risk of death in this patient population.

Cited by 34 publications

References 37 publications

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

Association between ventilatory settings and development of acute respiratory distress syndrome in mechanically ventilated patients due to brain injury

The effect of demographics and patient location on the outcome of patients with acute respiratory distress syndrome

Association between chronic exposure to air pollution and mortality in the acute respiratory distress syndrome

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