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Critical Care
Published in: Critical Care 5/2007

Open Access 01-10-2007 | Research

Clinical risk conditions for acute lung injury in the intensive care unit and hospital ward: a prospective observational study

Authors: Niall D Ferguson, Fernando Frutos-Vivar, Andrés Esteban, Federico Gordo, Teresa Honrubia, Oscar Peñuelas, Alejandro Algora, Gema García, Alejandra Bustos, Inmaculada Rodríguez

Published in: Critical Care | Issue 5/2007

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Abstract

Background

Little is known about the development of acute lung injury outside the intensive care unit. We set out to document the following: the association between predefined clinical conditions and the development of acute lung injury by using the American–European consensus definition; the frequency of lung injury development outside the intensive care unit; and the temporal relationship between antecedent clinical risk conditions, intensive care admission, and diagnosis of lung injury.

Methods

We conducted a 4-month prospective observational study in three Spanish teaching hospitals, enrolling consecutive patients who developed clinical conditions previously linked to lung injury, both inside and outside the intensive care unit. Patients were followed prospectively for outcomes, including the diagnosis of acute lung injury or acute respiratory distress syndrome.

Results

A total 815 patients were identified with at least one clinical insult; the most common were sepsis, pneumonia, and pancreatitis. Pulmonary risk conditions were observed in 30% of cases. Fifty-three patients (6.5%) developed acute lung injury; 33 of these (4.0%) met criteria for acute respiratory distress syndrome. Lung injury occurred most commonly in the setting of sepsis (46/53; 86.7%), but shock (21/59; 36%) and pneumonia (20/211; 9.5%) portended the highest proportional risk; this risk was higher in patients with increasing numbers of clinical risk conditions (2.2%, 14%, and 21% (P < 0.001) in patients with one, two, and three conditions, respectively). Median days (interquartile range) from risk condition to diagnosis of lung injury was shorter with pulmonary (0 (0 to 2)) versus extrapulmonary (3 (1 to 5)) (P = 0.029) risk conditions. Admission to the intensive care unit was provided to 9/20 (45%) patients with acute lung injury and to 29/33 (88%) of those with acute respiratory distress syndrome. Lung injury patients had higher mortality than others (acute lung injury 25.0%; acute respiratory distress syndrome 45.5%; others 10.3%; P < 0.001).

Conclusion

The time course from clinical insult to diagnosis of lung injury was rapid, but may be longer for extrapulmonary cases. Some patients with lung injury receive care and die outside the intensive care unit; this observation needs further study.
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Literature
1.
Lesur O, Berthiaume Y, Blaise G, Damas P, Deland E, Guimond JG, Michel RP: Acute respiratory distress syndrome: 30 years later. Can Resp J 1999, 6: 71-86.
2.
Ware LB, Matthay MA: The acute respiratory distress syndrome. N Engl J Med 2000, 342: 1334-1349. 10.1056/NEJM200005043421806CrossRefPubMed
3.
Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy , LeGall JR, Morris A, Spragg R: Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 1994, 20: 225-232. 10.1007/BF01704707CrossRefPubMed
4.
Lyons WS: Advancing the concept of two distinct ARDSs. J Trauma Injury Infect Crit Care 2000, 48: 188. 10.1097/00005373-200001000-00039CrossRef
5.
Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L, Pesenti A: Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 1999, 213: 545-552.CrossRefPubMed
6.
Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A: Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease: different syndromes? Am J Resp Crit Care Med 1998, 158: 3-11.CrossRefPubMed
7.
Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD: Incidence and outcomes of acute lung injury. N Engl J Med 2005, 353: 1685-1693. 10.1056/NEJMoa050333CrossRefPubMed
8.
The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000, 342: 1301-1308. 10.1056/NEJM200005043421801CrossRef
9.
Bersten AD, Edibam C, Hunt T, Moran J: Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. Am J Respir Crit Care Med 2002, 165: 443-448.CrossRefPubMed
10.
Goss CH, Brower RG, Hudson LD, Rubenfeld GD, ARDS Network: Incidence of acute lung injury in the United States. Crit Care Med 2003, 31: 1607-1611. 10.1097/01.CCM.0000063475.65751.1DCrossRefPubMed
11.
Luhr OR, Antonsen K, Karlsson M, Aardal S, Thorsteinsson A, Frostell CG, Bonde J: Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Resp Crit Care Med 1999, 159: 1849-1861.CrossRefPubMed
12.
Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F: Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Resp Crit Care Med 1998, 158: 1076-1081.CrossRefPubMed
13.
Ferguson ND, Frutos-Vivar F, Esteban A, Anzueto A, Alia I, Brower RG, Stewart TE, Apezteguia C, Gonzalez M, Soto L, et al.: Airway pressures, tidal volumes and mortality in patients with the acute respiratory distress syndrome. Crit Care Med 2005, 33: 21-30. 10.1097/01.CCM.0000150652.91411.66CrossRefPubMed
14.
Brun-Buisson C, Minelli C, Bertolini G, Brazzi L, Pimentel J, Lewandowski K, Bion J, Romand JA, Villar J, Thorsteinsson A, et al.: Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med 2004, 30: 51-61. 10.1007/s00134-003-2022-6CrossRefPubMed
15.
Roupie E, Lepage E, Wysocki M, Fagon JY, Chastre J, Dreyfuss D, Mentec H, Carlet J, Brun-Buisson C, Lemaire F, et al.: Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF Collaborative Group on Mechanical Ventilation. Societe de Reanimation de Langue Francaise. Intensive Care Med 1999, 25: 920-929. 10.1007/s001340050983CrossRefPubMed
16.
Roca O, Sacanell J, Laborda C, Pérez M, Sabater J, Burgueño MJ, Domínguez L, Masclans JR: Estudio de cohortes sobre incidencia de SDRA en pacientes ingresados en UCI y factores pronósticos de mortalidad. Medicina Intensiva 2006, 30: 6-12.CrossRefPubMed
17.
Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ: Clinical predictors of the adult respiratory distress syndrome. Am J Surg 1982, 144: 124-130. 10.1016/0002-9610(82)90612-2CrossRefPubMed
18.
Fowler AA, Hamman RF, Good JT, Benson KN, Baird M, Eberle DJ, Petty TL, Hyers TM: Adult respiratory distress syndrome: risk with common predispositions. Ann Int Med 1983, 98: 593-597.CrossRefPubMed
19.
Hudson LD, Milberg JA, Anardi D, Maunder RJ: Clinical risks for development of the acute respiratory distress syndrome. Am J Resp Crit Care Med 1995, 151: 293-301.CrossRefPubMed
20.
Hudson LD, Steinberg KP: Epidemiology of acute lung injury and ARDS. Chest 1999, 116: 74S-82S. 10.1378/chest.116.suppl_1.74S-aCrossRefPubMed
21.
Quartin AA, RM HS: Acute lung injury: is the intensive care unit the tip of the iceberg? Crit Care Med 2003, 31: 1860-1861. 10.1097/01.CCM.0000063444.28173.79CrossRefPubMed
22.
23.
Stewart TE, Meade MO, Cook DJ, Granton JT, Hodder RV, Lapinsky SE, Mazer CD, McLean RF, Rogovein TS, Schouten BD, et al.: Evaluation of a ventilation strategy to prevent barotrauma in patients at high risk for acute respiratory distress syndrome. Pressure- and Volume-Limited Ventilation Strategy Group. N Engl J Med 1998, 338: 355-361. 10.1056/NEJM199802053380603CrossRefPubMed
24.
Bone RC, Sibbald WJ, Sprung CL: The ACCP-SCCM consensus conference on sepsis and organ failure. Chest 1992, 101: 1481-1483. 10.1378/chest.101.6.1481CrossRefPubMed
25.
Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C: Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Int Med 1998, 129: 433-440.CrossRefPubMed
26.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ: Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995, 23: 1638-1652. 10.1097/00003246-199510000-00007CrossRefPubMed
27.
Grossman RF, Fein A: Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Chest 2000, 117: 177S-181S. 10.1378/chest.117.4_suppl_2.177SCrossRefPubMed
28.
Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA: Identification of patients with acute lung injury. Predictors of mortality. Am J Resp Crit Care Med 1995, 152: 1818-1824.CrossRefPubMed
29.
Zilberberg MD, Epstein SK: Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Resp Crit Care Med 1998, 157: 1159-1164.CrossRefPubMed
30.
Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A: Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005, 365: 2091-2097. 10.1016/S0140-6736(05)66733-5CrossRefPubMed
31.
Ball C, Kirkby M, Williams S: Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study. BMJ 2003, 327: 1014-1016. 10.1136/bmj.327.7422.1014PubMedCentralCrossRefPubMed
Metadata
Title
Clinical risk conditions for acute lung injury in the intensive care unit and hospital ward: a prospective observational study
Authors
Niall D Ferguson
Fernando Frutos-Vivar
Andrés Esteban
Federico Gordo
Teresa Honrubia
Oscar Peñuelas
Alejandro Algora
Gema García
Alejandra Bustos
Inmaculada Rodríguez
Publication date
01-10-2007
Publisher
BioMed Central
Published in
Critical Care / Issue 5/2007
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc6113

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