Incidence and outcome of acute lung injury and acute respiratory distress syndrome in the surgical intensive care unit

Abstract

Introduction:To determine the incidence and mortality of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in a cohort of patients with risk factors admitted to the Surgical Intensive Care Unit (SICU).Materials and Methods:A prospective observational inception cohort study with no intervention was conducted over 12 months. All patients with at least one known risk factor for ALI/ARDS admitted to the SICU were included in the study. The APACHE II severity of disease classification system scoring was performed within 1 h of admission. The ventilatory parameters and chest radiographs were recorded every 24 h. The P/F ratio, PEEP and Lung Injury Score were calculated each day until the day of discharge from the Intensive Care Unit or for the first 7 days of admission, whichever was shorter.Results:The incidence of ARDS among those who were mechanically ventilated was 11.4%. Sepsis was the most common (34.6%) etiology. Among those with risk factors, the incidence of ARDS was 30% and that of ALI was 32.7%. The mortality in those with ARDS was 41.8%. Those who develop ARDS had higher APACHE II scores, lower pH and higher PaCO2 at admission compared with those who developed ALI or no lung injury.Conclusion:The incidence and mortality of ARDS was similar to other studies. Identifying those with risk factors for ARDS or mortality will enable appropriate interventional measures.

Use of corticosteroids in acute respiratory distress syndrome: Perspective from an Indian intensive care unit

“…10,11,15 Sepsis continues to be the leading cause of ARDS and is often associated with tropical illnesses, including malaria, leptospirosis, dengue, etc., seen in a predominantly male population with occupational exposure to unsanitary environmental conditions. 10,11,15,16 Consistent with these studies, 10,11,16 our patients too showed similar demographic and etiological characteristics, but the microbiological yield of our patients was significantly lesser (17.9%) vs. the 40-50% range noted by our Indian colleagues. This can partially be explained by the nature of patients presenting to our tertiary referral center who have often times been admitted at other centers and received multiple doses of antimicrobials.…”

“…This can partially be explained by the nature of patients presenting to our tertiary referral center who have often times been admitted at other centers and received multiple doses of antimicrobials. The mortality in our patients was 53.7%, which, despite being comparable to other Indian studies, 10,11,[15][16][17] is significantly higher than the 15-30% noted in Western literature. 2,5 Our study had certain limitations as well.…”

Current incidence and outcome of the acute respiratory distress syndrome

“…Population structure, burden of disease, and risk factors for ARDS might differ between the developed and developing countries. Singh et al [10] performed a prospective observational study to examine the prevalence of ARDS, as defined by the AECC criteria, in patients admitted during a 12-month period in a surgical ICU of a large tertiary care hospital in India. From a total of 902 admissions, they identified 67 (7.4%) patients meeting the AECC criteria for ARDS.…”

Особливості Діагностики Гострої Дихальної Недостатності У Дітей Із Сепсисом

“…Такі пацієнти мають вищий рівень ле-тальності (30-60 %) порівняно з хворими, в яких є інші причини розвитку ГРДС (рівень летальності не перевищує 30 %) [2,3]. Важливою є рання іден-тифікація пацієнтів із ризиком виникнення ГРДС.…”

“…Аналізуючи міжнародні дослідження, можна ви-окремити певні біохімічні показники, що вірогідно вирізняються у тих пацієнтів із сепсисом, в яких у подальшому розвинеться ГРДС. Зокрема, при над-ходженні до лікарні у таких хворих є вищий рівень поліорганної дисфункції та paCO 2 , нижчий рівень pH порівняно з тими, в кого не було ураження ле-гень [2]. ГРДС є гетерогенним синдромом, домінуючу роль у розвитку якого відіграє ушкодження аль-веоло-капілярної мембрани та підвищення її про-никності [1].…”