Luhr OR, Antonsen K, Karlsson M, et al: Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland: The ARF Study Group. Am J Respir Crit Care Med 159: 1849-1861

Division of Anaesthesia and Intensive Care, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 07/1999; 159(6):1849-61. DOI: 10.1164/ajrccm.159.6.9808136
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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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    • "Other studies over the past 20 years have reported that mortality from ALI/ARDS has decreased [13] [14] "
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    ABSTRACT: Aim of the study To identify outcome improvement factors in ARDS patients managed with lung protective ventilation and defined according to the Berlin diagnostic criteria. Patients and methods A retrospective observational study was conducted in a total of 41 ARDS patients who were diagnosed according to the Berlin ARDS criteria. Demographic, clinical, laboratory, and radiological criteria were assessed for all patients, and sputum, blood, and urine samples were obtained on the first day of hospitalization and on the day of ventilator-associated pneumonia diagnosis. In addition, fluid balance was assessed by the end of the first week of ventilation. Significant factors associated with survival improvement and predictors of mortality were identified using the bivariate analysis. ROC curves were created to evaluate the accuracy of some of the factors affecting survival. Results In this study 25 variables were significantly correlated with mortality. The non-surviving patients had tachypnea and tachycardia; lower diastolic blood pressure, PaO2/FiO2, PO2, O2sat, and HCO3 values; and higher FiO2 and PCO2 values. Additionally, they had lower serum Na and higher K, pH, and creatinine levels. The level of CRP and GCS score were significantly lower in the non-surviving patients. However, the average fluid balance in the non-surviving patients was positive. Additionally, 4 non-surviving patients (33.3%) developed hospital-acquired pneumonia. A good general condition, indicated by a GCS score was the most accurate improvement prediction factor, then proper oxygenation. In contrast, a delay in ICU admission, increase in serum creatinine level, and a positive fluid balance were accurate predictive factors of mortality. Conclusions Early diagnosis and ICU admission, a PaO2/FiO2 ratio maintained above 90, a GCS score above 9, a negative fluid balance, a serum creatinine level less than 1.5 mg/dl, and the prevention of HAP were factors associated with an improved outcome in ARDS.
    10/2014; 63(4). DOI:10.1016/j.ejcdt.2014.07.010
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    • "17.9 and 13.5 patients per 100,000/yr, respectively. These figures were reported by Luhr OR in 1999 and associated with a significantly higher mortality [23]. In addition, he reported that the ninety-day mortality was 41.0% for ARF, which included ALI and ARDS patients reported on in the American Journal of Respiratory and Critical Care Medicine [24]. "
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    ABSTRACT: Acute lung injury (ALI) is an inflammatory disorder associated with reduced alveolar-capillary barrier function and increased pulmonary vascular permeability. Vasodilator-stimulated phosphoprotein (VASP) is widely associated with all types of modulations of cytoskeleton rearrangement-dependent cellular morphology and function, such as adhesion, shrinkage, and permeability. The present studies were conducted to investigate the effects and mechanisms by which tumor necrosis factor-alpha (TNF-α) increases the tight junction permeability in lung tissue associated with acute lung inflammation. After incubating A549 cells for 24 hours with different concentrations (0-100 ng/mL) of TNF-α, 0.1 to 8 ng/mL TNF-α exhibited no significant effect on cell viability compared with the 0 ng/mL TNF-α group (control group). However, 10 ng/mL and 100 ng/mL TNF-α dramatically inhibited the viability of A549 cells compared with the control group (*p<0.05). Monolayer cell permeability assay results indicated that A549 cells incubated with 10 ng/mL TNF-α for 24 hours displayed significantly increased cell permeability (*p<0.05). Moreover, the inhibition of VASP expression increased the cell permeability (*p<0.05). Pretreating A549 cells with cobalt chloride (to mimic a hypoxia environment) increased protein expression level of hypoxia inducible factor-1α (HIF-1α) (*p<0.05), whereas protein expression level of VASP decreased significantly (*p<0.05). In LPS-induced ALI mice, the concentrations of TNF-α in lung tissues and serum significantly increased at one hour, and the value reached a peak at four hours. Moreover, the Evans Blue absorption value of the mouse lung tissues reached a peak at four hours. The HIF-1α protein expression level in mouse lung tissues increased significantly at four hours and eight hours (**p<0.001), whereas the VASP protein expression level decreased significantly (**p<0.01). Taken together, our data demonstrate that HIF-1α acts downstream of TNF-α to inhibit VASP expression and to modulate the acute pulmonary inflammation process, and these molecules play an important role in the impairment of the alveolar-capillary barrier.
    PLoS ONE 07/2014; 9(7):e102967. DOI:10.1371/journal.pone.0102967 · 3.23 Impact Factor
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    • "Respiratory failure is a common cause of illness and death, the cost to society in terms of lost productivity and shortened lives is enormous [1]. Mortality rates in Intensive Care Units (ICUs) in Europe were around 40% [2] [3], and epidemiological studies suggest that respiratory failure will become more common as the population ages, increasing by as much as 80% in the next 20 years [1]. For many years, patients who developed respiratory failure had to be put on invasive MV, but it caused many severe complications in those patients, so the recent critical care literature has shown an outburst of articles on non-invasive respiratory ventilation for patients with respiratory failure of varied etiology , with numerous published randomized controlled trials and meta-analysis on this topic [4] [5] [6] [7] [8]. "
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    ABSTRACT: In clinical practice, physicians have recently attempted to avoid mechanical ventilation (MV) as much as possible and have started to use non-invasive ventilation (NIV) in patients with respiratory failure. A prospective observational study was conducted to assess the applicability, effectiveness, and safety of NIV in managing patients with respiratory failure in Palestine. Fifty-two patients (39 patients from West Bank and 13 patients from Gaza Strip) who fulfilled criteria for inclusion were admitted to the two medical care units of the An-Najah National Teaching Hospital during a 10-month period. These patients formed the study population to receive NIV. The results came with baseline (mean ± SD) pH, PaO2, and PaCO2 measurements of 7.36 ± 0.1, 75.62 ± 32.7, and 46.5 ± 20.86 mmHg, respectively. The primary indication for NIV was hypoxemic respiratory failure (n = 38, 73%). The success rate with NIV was 78%, with 40 out of 52 patients weaned successfully. Significant improvements were observed in the first hour following institution of NIV in pH (7.38 ± 0.07, P < 0.001), PaO2 (90.4 ± 52.4, P < 0.001), and PaCO2 (40.4 ± 12.6, P < 0.001). These physiological parameters continued to improve up to the time of weaning: pH (7.39 ± 0.07, P < 0.001), PaO2 (99.9 ± 44.3, P < 0.001), and PaCO2 (38.6 ± 13.9, P < 0.001). The parameters were maintained within 12 h post-weaning: pH (7.39 ± 0.08, P < 0.001), PaO2 (97 ± 30.3, P < 0.001), and PaCO2 (36.9 ± 10.3, P < 0.001). This study has shown benefits of NIV in avoiding the call for invasive MV in patients exhibiting respiratory failure of varied etiology, with similar results comparable to previous studies in developed countries. Thus, increased usage of NIV in respiratory failure is likely to affect favorably in countries with limited resources such as Palestine.
    07/2014; 2(1). DOI:10.1016/j.ejccm.2014.07.002
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