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

TLDR

A consensus conference introduced uniform criteria for acute lung injury to enable earlier identification, but these criteria had not yet been prospectively validated. The study aimed to determine whether applying the new criteria changes clinical characteristics, risk factors, or mortality predictors compared with prior ARDS studies, and to evaluate whether a severity index predicts nonsurvivors. Researchers prospectively identified 123 patients using PaO₂/FiO₂ < 300 with bilateral infiltrates, scored injury severity on a four-point scale, and performed stepwise logistic regression, enrolling 66 patients with PaO₂/FiO₂ 150–299 and 57 with < 150. Hospital mortality was 58%, with sepsis the most frequent underlying disorder (41%). Abstract truncated at 250 words.

Abstract

A recent North-American-European Consensus Conference proposed new, uniform criteria for the definition of acute lung injury, in part to facilitate earlier identification of patients for clinical trials. However, these criteria have not been evaluated prospectively. We designed a prospective cohort study of 123 consecutive patients with acute lung injury prospectively identified on admission to the adult intensive care units of a tertiary care university hospital. The objectives were to determine if selection of patients using the new criteria for acute lung injury results in a significant change in the clinical characteristics, risk factors, or predictors of mortality when compared with prior studies of patients with adult respiratory distress syndrome (ARDS); and to determine if a quantitative index of the severity of acute lung injury has prognostic value in identifying nonsurvivors of acute lung injury. We used three methods: (1) prospective identification of patients with acute lung injury using a PaO2/FIO2 ratio < 300 and bilateral infiltrates on chest radiograph in the absence of left heart failure; (2) evaluation of the severity of lung injury using a four-point scoring system; and (3) stepwise logistic regression analysis to identify variables significantly associated with hospital mortality. Overall hospital mortality was 58%. Sepsis was the most common clinical disorder (50/123 or 41%) associated with the development of acute lung injury. Using the new definition for acute lung injury, 66 of the 123 patients were enrolled with a PaO2/FIO2 ratio between 150 and 299; 57 of the 123 patients had a PaO2/FIO2 < 150 at the time of entry into the study. (ABSTRACT TRUNCATED AT 250 WORDS)