Acute lung injury: a 1 year study at an intensive care unit of a university hospital

Introduction

In 1994 a North American–European Consensus Conference published new criteria defining Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). However, few epidemiological studies regarding ALI/ARDS have been published since then. Our objectives were to determine the incidence of ALI/ARDS, its mortality and the influence of risk factors, comorbidities and organ dysfunction on mortality in ALI/ARDS patients.

Methods

A prospective cohort study enrolled all patients admitted to the Intensive Care Unit (ICU) of a general university hospital that remained for more than 24 hours at the ICU. They were evaluated regarding the presence/development of ALI/ARDS according to the Consensus criteria. All patients were analyzed regarding mortality, risk factors, comorbidities and organ dysfunction.

Results

1202 patients were studied (mean age: 56 ± 17 years; 674 males, 528 females; Apache II: 13.4 ± 8.7). The incidence of ALI was 3.9% (n = 47), of which, ARDS was 2.4% (n = 29) and ALI non-ARDS was 1.5% (n = 18). The ICU mortality of patients with ALI was 45% (ARDS = 48%; ALI non-ARDS = 39%, not significantly different). A multivariate analysis suggested that acute renal failure (P = 0.001); hematological dysfunction (P = 0.035) and prolonged hypotension (P = 0.001) were associated with higher mortality in ALI patients.

Conclusion

1) The total incidence of ALI was 3.9%; the incidence of ARDS was slightly higher than that of ALI non-ARDS. 2) The total mortality of ALI patients was 45%; the mortality of ARDS patients was slightly higher than that of ALI non-ARDS patients. 3) Acute renal failure, hematological dysfunction and prolonged hypotension were associated with mortality. This report is, to our knowledge, the first epidemiological report in South America studying ALI/ARDS using the Consensus criteria.

Note

ARDS research group: G Torres, R Butteli, JF Pires, F de la Veja, JH Diehl, M Premaor, AR Vacari, T Rosito, V Diemen, F Fernandes, C Marc, C Peukert, C Stapenhorst, C Borges, C Schneider, C Bete, C Ortiz, M Furtado, E Silveira, E Cappelari, R Melo, D Ughini, W Weishaimer Jr, M Bozzetti.