Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.

Division of Anaesthesia and Intensive Care, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 11.99). 07/1999; 159(6):1849-61. DOI: 10.1164/ajrccm.159.6.9808136
Source: PubMed

ABSTRACT To determine the incidence and 90-d mortality of acute respiratory failure (ARF), acute lung injury (ALI), and the acute respiratory distress syndrome (ARDS), we carried out an 8-wk prospective cohort study in Sweden, Denmark, and Iceland. All intensive care unit (ICU) admissions (n = 13,346) >/= 15 yr of age were assessed between October 6th and November 30th, 1997 in 132 of 150 ICUs with resources to treat patients with intubation and mechanical ventilation (I + MV) >/= 24 h. ARF was defined as I + MV >/= 24 h. ALI and ARDS were defined using criteria recommended by the American-European Consensus Conference on ARDS. Calculation to correct the incidence for unidentified subjects from nonparticipating ICUs was made. No correction for in- or out-migration from the study area was possible. The population in the three countries >/= 15 yr of age was 11.74 million. One thousand two hundred thirty-one ARF patients were included, 287 ALI and 221 ARDS patients were identified. The incidences were for ARF 77.6, for ALI 17.9, and for ARDS 13.5 patients per 100,000/yr. Ninety-day mortality was 41.0% for ARF, including ALI and ARDS patients, 42.2% for ALI not fulfilling ARDS criteria, and 41.2% for ARDS.

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    ABSTRACT: Acute respiratory distress syndrome (ARDS) and sepsis are common problems on the intensive care unit, both with considerable morbidity and mortality. Although separate entities, these two disease processes are closely linked in terms of pathophysiology; they share many of the same inflammatory pathways and cellular interactions. In addition, while ARDS by name is primarily a disease of the lung, it is actually, like sepsis, a systemic condition with multiple widespread effects on various other organs and tissues. Definition of ARDS In early descriptions by Ashbaugh et al. [1], the combination of acute onset of severe dyspnoea, tachypnoea, cyanosis (hypoxaemia) refractory to oxygen therapy, diffuse abnormalities on chest radiographs, and decreased lung compliance was termed "acute respiratory distress syndrome of adults"; this later became "adult" respiratory distress syndrome [2] and then "acute" respiratory distress syndrome with the realisation that children could develop the syndrome as well (different to infant respiratory distress syndrome (IRDS) in which a lack of surfactant is the key problem), but the abbreviation remains the same: ARDS. As mentioned in the early descriptions, ARDS is diagnosed clinically by the association of severe hypoxaemia, bilateral infiltrates on chest radiograph and the absence of any evidence of increased hydrostatic pressure. According to the widely accepted 1992 American-European Consensus Conference definitions [3], ARDS is defined by the presence of bilateral pulmonary infiltrates on chest radiograph, a pulmonary artery occlusion pressure of v18 mmHg, and an arterial oxygen tension/ inspiratory oxygen fraction ratio of v200 (v300 for the milder form, acute lung injury (ALI); fig. 1). ARDS can be primary (due to pneumonia or other direct injuries to the lungs) or secondary to distant events (sepsis elsewhere, pancreatitis, etc; table 1). Interestingly, the lungs react similarly whether they are submitted to direct or indirect injury.
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    ABSTRACT: 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).
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May 19, 2014