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

Singh G, Gladdy G, Chandy TT, Sen N - Indian J Crit Care Med (2014)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

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.

No MeSH data available.


Related in: MedlinePlus

Pattern of PEEP among survivors and non-survivors of acute respiratory distress syndrome
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Figure 4: Pattern of PEEP among survivors and non-survivors of acute respiratory distress syndrome

Mentions: From Table 6, it can be noted that although the PaO2/FiO2 ratio of the non-survivors of ARDS was higher compared with the survivors on Day one, the trend changed on Day 4, with non-survivors showing a consistently lower PaO2/FiO2 ratio thereafter. The mean LIS of the non-survivors of ARDS was higher on Day 1, and continued to be so until death. The radiological injury did not show any significant difference until Day 4, from when the non-survivor group showed a consistently higher injury. The mean PEEP in the non-survivor group remained consistently high since the onset of the inciting insult, which implies that those who required higher PEEP to maintain oxygenation were at higher risk of death due to ARDS. This is demonstrated in Figures 1–4. The lung injury, as evidenced by low P/F ratio, higher PEEP and more number of radiological quadrants involved, are more pronounced on Day 4 than on the day of onset of illness. This may be because of the large number of patients with extrapulmonary causes of ARDS.


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

Singh G, Gladdy G, Chandy TT, Sen N - Indian J Crit Care Med (2014)

Pattern of PEEP among survivors and non-survivors of acute respiratory distress syndrome
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195196&req=5

Figure 4: Pattern of PEEP among survivors and non-survivors of acute respiratory distress syndrome
Mentions: From Table 6, it can be noted that although the PaO2/FiO2 ratio of the non-survivors of ARDS was higher compared with the survivors on Day one, the trend changed on Day 4, with non-survivors showing a consistently lower PaO2/FiO2 ratio thereafter. The mean LIS of the non-survivors of ARDS was higher on Day 1, and continued to be so until death. The radiological injury did not show any significant difference until Day 4, from when the non-survivor group showed a consistently higher injury. The mean PEEP in the non-survivor group remained consistently high since the onset of the inciting insult, which implies that those who required higher PEEP to maintain oxygenation were at higher risk of death due to ARDS. This is demonstrated in Figures 1–4. The lung injury, as evidenced by low P/F ratio, higher PEEP and more number of radiological quadrants involved, are more pronounced on Day 4 than on the day of onset of illness. This may be because of the large number of patients with extrapulmonary causes of ARDS.

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

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.

No MeSH data available.


Related in: MedlinePlus