Risk factors for the development of acute lung injury in patients with septic shock: An observational cohort study

Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clini), Rochester, Minnesota, USA.
Critical care medicine (Impact Factor: 6.31). 05/2008; 36(5):1518-22. DOI: 10.1097/CCM.0b013e31816fc2c0
Source: PubMed


Almost half of the patients with septic shock develop acute lung injury (ALI). The understanding why some patients do and others do not develop ALI is limited. The objective of this study was to test the hypothesis that delayed treatment of septic shock is associated with the development of ALI.
Observational cohort study.
Medical intensive care unit in a tertiary medical center.
Prospectively identified patients with septic shock who did not have ALI at the outset, excluding those who denied research authorization.
High frequency cardio-respiratory monitoring, arterial gas analysis, and portable chest radiographs were reviewed to identify the timing of ALI development. Risk factors present before ALI development were identified by review of electronic medical records and analyzed in univariate and multivariate analyses. Seventy-one of 160 patients (44%) developed ALI at a median of 5 (range 2-94) hours after the onset of septic shock. Multivariate logistic regression analysis identified the following predictors of ALI development: delayed goal-directed resuscitation (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.52-8.63, p = .004), delayed antibiotics (OR 2.39, 95% CI 1.06 -5.59, p = .039), transfusion (OR 2.75, 95% CI 1.22-6.37, p = .016), alcohol abuse (OR 2.09, 95% CI .88-5.10, p = 0.098), recent chemotherapy (OR 6.47, 95% CI 1.99-24.9, p = 0.003), diabetes mellitus (OR .44, 95% CI .17-1.07, p = .076), and baseline respiratory rate (OR 2.03 per sd, 95% CI 1.38-3.08, p < .001).
When adjusted for known modifiers of ALI expression, delayed treatment of shock and infection were associated with development of ALI.

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    • "Intense investigation into both syndromes has resulted in little success in randomized controlled trials as well [6] [7]. Sepsis carries an estimated incidence of ARDS of more than 40% in some studies and is a leading cause of death in ARDS [8] [9] [10]. Finally, the clinical care and trajectory set forth at the most proximate time of presentation (eg, the emergency department [ED] and early intensive care unit [ICU]) are now recognized as increasingly impactful periods with respect to overall outcome [11] [12]. "
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    ABSTRACT: Purpose: Acute respiratory distress syndrome (ARDS) is associated with significant mortality and morbidity in survivors. Treatment is only supportive, therefore elucidating modifiable factors that could prevent ARDS could have a profound impact on outcome. The impact that sepsis-associated cardiac dysfunction has on ARDS is not known. Materials and methods: In this retrospective observational cohort study of mechanically ventilated patients with severe sepsis and septic shock, 122 patients were assessed for the impact of sepsis-associated cardiac dysfunction on incidence of ARDS (primary outcome) and mortality. Results: Sepsis-associated cardiac dysfunction occurred in 44 patients (36.1%). There was no association of sepsis-associated cardiac dysfunction with ARDS incidence (p= 0.59) or mortality, and no association with outcomes in patients that did progress to ARDS after admission. Multivariable logistic regression demonstrated that higher BMI was associated with progression to ARDS (adjusted OR 11.84, 95% CI 1.24 to 113.0, p= 0.02). Conclusions: Cardiac dysfunction in mechanically ventilated patients with sepsis did not impact ARDS incidence, clinical outcome in ARDS patients, or mortality. This contrasts against previous investigations demonstrating an influence of nonpulmonary organ dysfunction on outcome in ARDS. Given the frequency of ARDS as a sequela of sepsis, the impact of cardiac dysfunction on outcome should be further studied.
    Journal of Critical Care 08/2014; 30(1). DOI:10.1016/j.jcrc.2014.07.027 · 2.00 Impact Factor
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    • "Surprisingly little research has been done on the prevention of ALI. Preliminary data suggest that ALI is rarely present at the time of hospital admission but develops over a period of hours to days in subsets of patients with predisposing conditions [4] [5]. To this extent, ALI may be viewed as potentially preventable hospital complication similar to stress ulcer bleeding, venous thromboembolism or nosocomial infections [6]. "
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    ABSTRACT: Background Acute lung injury (ALI) is an example of a critical care syndrome with few therapeutic modalities once the syndrome is fully established, and little has been done on the prevention of ALI. Aim of the work The aim of this work was to early identify the onset of acute lung injury (ALI) on admission and to prospectively evaluate the lung injury prediction score (LIPS). Patients and methods The study was carried out on 100 patients who aged >18 years, patients who had one or more of the acute lung injury (ALI) predisposing conditions on admission or within 6 h after were subjected to lung injury prediction score (LIPS). Results Acute lung injury developed in 15 patients, 11 patients (73.3%) had LIPS >3, while 4 patients (26.7%) had LIPS ⩽3 and only 4.70% of those who didn’t develop ALI had LIPS >3, with a statistically significant relationship between patients above and below LIPS value of 3 (P = 0.000), LIPS cutoff value of ⩾3.5 on admission had a 73% sensitivity and 95% specificity with an area under the receiver operating curve of 0.883 (95% CI 0.782 to 0.984). Sepsis and pneumonia were the most frequent risk factors (60%). Conclusions Lung injury predictive score (LIPS) could early predict patients at risk to develop ALI on admission, Hyperbilirubinemia, high blood urea level and abnormal chest X-ray on admission were not included in the original LIPS but had significant association with development of ALI.
    10/2013; 62(4). DOI:10.1016/j.ejcdt.2013.08.014
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    • "Zilberberg et al. [48] showed that more patients who developed ARDS had received red cell transfusions than those who did not develop ARDS; moreover, they found that transfusion of greater amounts increased the risk of developing ARDS. Many authors have since confirmed this association [7,45,49,50]. "
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    ABSTRACT: Acute respiratory distress syndrome (ARDS) is common in critically ill patients admitted to intensive care units (ICU). ARDS results in increased use of critical care resources and healthcare costs, yet the overall mortality associated with these conditions remains high. Research focusing on preventing ARDS and identifying patients at risk of developing ARDS is necessary to develop strategies to alter the clinical course and progression of the disease. To date, few strategies have shown clear benefits. One of the most important obstacles to preventive interventions is the difficulty of identifying patients likely to develop ARDS. Identifying patients at risk and implementing prevention strategies in this group are key factors in preventing ARDS. This review will discuss early identification of at-risk patients and the current prevention strategies.
    Annals of Intensive Care 04/2013; 3(1):11. DOI:10.1186/2110-5820-3-11 · 3.31 Impact Factor
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