Identification of patients with acute lung injury. Predictors of mortality.

Doyle, Ramona L.; Szaflarski, Nancy L.; Modin, Gunnard; Wiener-Kronish, J. P.; Matthay, Michael A.

doi:10.1164/ajrccm.152.6.8520742

Cited by 455 publications

(315 citation statements)

References 22 publications

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“…Initial use of combination therapy reduces the likelihood of inappropriate therapy, and has been recommended to avoid the emergence of antimicrobial resistance and to enhance the killing produced by antimicrobials acting synergistically, particularly against VAP produced by P. aeruginosa. 2 However, Garnacho-Montero et al 21 demonstrated that monotherapy with only one active antibiotic provided similar outcomes compared with combination therapy with two active antimicrobials, and suggested that switching to monotherapy once the susceptibility is documented was feasible and safe even against P. aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

“…The assessment of acute lung injury included evaluation of the chest radiograph and arterial oxygenation using the PaO 2 /FiO 2 coefficient (partial pressure of arterial oxygen to the fraction of inspired oxygen). 2 We defined the presence of the acute respiratory distress syndrome as the presence of a generalized pulmonary infiltrate and a lung injury score 42.5, 14 and the presence of shock as systolic arterial pressure of o90 mm Hg with signs of peripheral hypoperfusion or need for continuous infusion of vasopressor or inotropic agents.…”

Section: Methodsmentioning

confidence: 99%

“…1 The clinical importance of VAP is demonstrated by several investigations, suggesting that its occurrence is an independent determinant of mortality for critically ill patients requiring mechanical ventilation. 2,3 Crude mortality rates vary from 25 to 50%, whereas directly attributable mortality is 27%. 4 In patients who receive mechanical ventilation, 5% remain unweanable after 4 weeks and have been classified as chronic ventilator-dependent patients.…”

Section: Introductionmentioning

confidence: 99%

“…10 Most of the studies that analyze the clinical and epidemiological characteristics of VAP refer to patients receiving mechanical ventilation for periods of o4 weeks. 1,2 Very few studies have analyzed these characteristics in patients with long-term ventilator-assisted individuals, 11,12 and to our knowledge, the overall characteristics of VAP has never been evaluated in this group of patients. In this study, we aimed to analyze the incidence, chronology, risk factors and the outcome of VAP in long-term ventilator-assisted individuals.…”

Section: Introductionmentioning

confidence: 99%

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Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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Background: Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients. Methods: All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) X10 5 CFU ml À1 in quantitative bacterial culture of tracheal aspirates or X10 3 CFU ml À1 in quantitative mini-bronchoalveolar lavage cultures. Results: In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P ¼ 0.03), administration of antacids (P ¼ 0.002) and length of mechanical ventilation (P ¼ 0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP. Conclusions: Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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“…One of the most frequently studied indices is the Pa,O 2 / FI,O 2 , although contradictory results concerning its ability to predict outcome have been reported in adult AHRF/ARDS [2,[27][28][29][30][31][32][33][34][35]. Some authors have argued that the ratio may not be predictive at inclusion, but after 24 or 48 h [30,31].…”

Section: Discussionmentioning

confidence: 99%

Incidence and short-term outcome of acute lung injury in mechanically ventilated children

Dahlem¹,

Aalderen²,

Hamaker³

et al. 2003

Eur Respir J

114

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The aim of this study was to determine the incidence and short-term outcome of mechanically ventilated children suffering from acute lung injury (ALI) on a paediatric intensive care unit (PICU).Between January 1 1998 and January 1 2000, all mechanically ventilated children were evaluated using the criteria of an American-European Consensus Conference.Of the 443 children eligible for analysis, 44 (9.9%) were diagnosed as suffering from ALI. Of these, 79.5% developed the acute respiratory distress syndrome (ARDS); 54.5% (24 of 44) fulfilled the ARDS criteria at inclusion and 25% (11 of 44) later. PICU mortality for ALI was 27.3% (12 of 44) and within the ARDS subgroup 31.4% (11 of 35). Of the 12 children who died, 11 had ARDS; the main cause of death was cerebral damage (seven of 12).Acute lung injury and acute respiratory distress syndrome are rare diseases on apaediatric intensive care unit with a high mortality. Most of the children with acutelung injury develop acute respiratory distress syndrome. In the acute respiratory distress syndrome subgroup, mortality is higher than in the acute lung injury nonacute respiratory distress syndrome subgroup. Further investigations should confirm prognostic factors (e.g.respiratory parameters) for prediction of outcome.

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Acute Respiratory Distress Syndrome in the Trauma Intensive Care Unit

et al. 2006

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Hypothesis: The diagnosis of acute respiratory distress syndrome (ARDS) carries significant additional morbidity and mortality among critically injured patients. Design: Retrospective case-control study using a prospectively maintained ARDS database. Setting: Surgical intensive care unit (ICU) in an academic county hospital. Patients: All trauma patients admitted to the ICU from January 1, 2000, to December 31, 2003, who developed ARDS as defined by (1) acute onset, (2) a partial pressure of arterial oxygen-fraction of inspired oxygen ratio of 200 or less, (3) bilateral pulmonary infiltrates on chest radiographs, and (4) absence of left-sided heart failure. Each patient with ARDS was matched with 2 control patients without ARDS on the basis of sex, age (±5 years), mechanism of injury (blunt or penetrating), Injury Severity Score (±3), and chest Abbreviated Injury Score (±1). Main Outcome Measures: Mortality, hospital charges, hospital and ICU lengths of stay, and complications (defined as pneumonia, deep venous thrombosis, pulmonary embolism, acute renal failure, and disseminated intravascular coagulopathy). Results: Of 2042 trauma ICU admissions, 216 patients (10.6%) met criteria for ARDS. We identified 432 similarly injured control patients. Compared with controls, trauma patients with ARDS had more complications (43.1% vs 9.5%), longer hospital (32.2 vs 17.9 days) and ICU (22.1 vs 8.4 days) lengths of stay, and higher hospital charges ($267 037 vs $136 680) (PϽ.01 for all), but mortality was similar (27.8% vs 25.0%, P=.48). Conclusion: Although ARDS is associated with increased morbidity, hospital and ICU length of stay, and costs, it does not increase overall mortality among critically ill trauma patients.

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Identification of patients with acute lung injury. Predictors of mortality.

Cited by 455 publications

References 22 publications

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Incidence and short-term outcome of acute lung injury in mechanically ventilated children

Acute Respiratory Distress Syndrome in the Trauma Intensive Care Unit

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