Impact of Distinct Definitions of Acute Lung Injury on Its Incidence and Outcomes in Brazilian ICUs

Abstract

In our population, prevalence of acute lung injury was low, most cases were diagnosed 2 days after ICU admission, and Berlin definition was not different from American European Consensus conference definition in predicting mortality. There are still several problems with the global epidemiology, definition, and mortality predictive indices that should be added to the classification of this still lethal syndrome to improve its predictive mortality power in the future.

Acute respiratory distress syndrome

“…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].…”

“…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].…”

“…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].…”

The Berlin definition met our needs: no

“…There are no data that link a particular baseline PaO 2 /FiO 2 to predictable structural changes in the alveolar-capillary membrane. Two recent studies [14,15] showed that the use of non-standardized baseline PaO 2 /FiO 2 were incapable of separating patients into distinct categories of severity with significantly different mortalities. An autopsy study revealed that the Berlin criteria did not correlate with the presence of diffuse alveolar damage in more than 50 % of patients categorized as moderate and severe ARDS [16].…”

Pediatric acute respiratory distress syndrome

“…Dünya genelinde insidansı 1.5-79/100.000 olarak bildirilmekle birlikte, Avrupa ülkelerinde bu oran Amerika Birleşik Devletleri (ABD)'den daha düşüktür (2,3,6) . Brezilya'da 2013 tarihli yapılan çok merkezli bir çalışmada, bu oran 100.000'de 1.8 ile 31 bulunmuştur (7,8) . Ancak bu çalışmalar daha çok erişkin yaş grubunu kapsamakta olup, pediyatrik yaş grubu için insidans verileri tam olarak bilinmemektedir (9) .…”