Acute lung injury and acute respiratory distress syndrome at the intensive care unit of a general university hospital in Brazil. An epidemiological study using the American-European Consensus Criteria.

摘要

OBJECTIVES: To determine: (1) the frequency of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); (2) the mortality associated with these syndromes and (3) the influence of risk factors, comorbidities and organ system dysfunction in the mortality of ALI patients. DESIGN: Prospective cohort study. SETTING: Intensive care unit (ICU) of a general university hospital in Brazil. PATIENTS AND PARTICIPANTS: All patients that remained in the ICU for more than 24 h were evaluated regarding the presence/development of ALI/ARDS according to the 1994 American-European Consensus Conference. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: One thousand three hundred and one patients were studied and analyzed regarding mortality, risk factors, comorbidities and organ system dysfunction(s). The frequency of ALI was 3.8% (50), of which ARDS was 2.3% (30) and ALIon-ARDS 1.5% (20) (p=0.15). The ICU mortality of patients with ALI was 44.0%; in ALIon-ARDS and ARDS patients it was 40.0% and 46.7%, respectively (p=0.43). The hospital mortality of ALI patients was 48.0%; in ALIon-ARDS and ARDS patients it was 50.0% and 46.7%, respectively (p=0.21). A multivariate analysis demonstrated that renal (ICU and hospital: p=0.002) and hematological dysfunction (ICU: p=0.008; hospital: p=0.02) were independently associated with ICU and hospital mortality in ALI patients. CONCLUSIONS: (1) The frequency of ALI was 3.8%, of which the frequency of ARDS was 2.3% and of ALIon-ARDS 1.5%; (2) The ICU and hospital mortality of ALI patients was 44.0% and 48.0%, respectively; mortality rates of ARDS and ALIon-ARDS did not differ significantly; (3) Renal and hematological dysfunction were associated with mortality in ALI patients.