Acute lung injury: surprisingly common in the neurologic intensive care unit.

摘要

Acute lung injury and the acute respiratory distress syndrome (ALI/ARDS) are syndromes of acute respiratory failure that most commonly occur in the setting of severe sepsis, pneumonia, or severe traumatic injuries (1). Patients with critical neurologic disorders have therefore not been well represented in investigations of risk factors for ALI/ARDS, which have focused largely on patients admitted to medical, surgical, or trauma intensive care units (ICUs) (2). Clinical trials of interventions for ALI/ARDS have also typically excluded patients with acute neurologic illness (4). As dedicated neurologic critical care units staffed by neurointensivists become more common, there is a real and growing need to better understand the incidence and risk factors for ALI/ ARDS among patients with neurologic critical illness. In this issue of Critical Care Medicine, Hoesch and colleagues (5) report the incidence of and risk factors for ALI/ARDS in a cohort of systemically evaluated patients who were mechanically ventilated for >48 hrs in the neurologic ICU at a large, academic medical center. Remarkably, over one third (68 of the 192 patients in the study) met stringent diagnostic criteria for ALI/ ARDS, suggesting that ALI/ARDS is one of the more common non-neurologic diagnoses encountered in the neurologic ICU setting.