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Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition.
- Source :
-
Intensive Care Medicine . Feb2016, Vol. 42 Issue 2, p164-172. 9p. - Publication Year :
- 2016
-
Abstract
- <bold>Purpose: </bold>Some patients presenting with acute respiratory failure and meeting the Berlin criteria for acute respiratory distress syndrome (ARDS) lack exposure to common risk factors (CRF). These so-called ARDS mimickers often lack histological diffuse alveolar damage. We aimed to describe such ARDS mimickers lacking CRF (ARDS CRF-) in comparison with others (ARDS CRF+).<bold>Methods: </bold>Retrospective study including all patients receiving invasive mechanical ventilation for ARDS admitted to the intensive care units (ICUs) of two tertiary care centers from January 2003 to December 2012.<bold>Results: </bold>The prevalence of ARDS CRF- was 7.5 % (95 % CI [5.5-9.5]; n = 50/665). On the basis of medical history, bronchoalveolar lavage fluid cytology, and chest CT scan patterns, four etiological categories were identified: immune (n = 18; 36 %), drug-induced (n = 13; 26 %), malignant (n = 7; 14 %), and idiopathic (n = 12; 24 %). Although the ARDS CRF- patients had a lower logistic organ dysfunction score (4 [3-8] vs. 10 [6-13]; p < 0.0001) and less often shock upon ICU admission (44 vs. 80 %; p < 0.0001) than their counterparts, their overall ICU mortality rate was very high (66 % [46-74]), and the absence of CRF remained associated with ICU mortality by multivariable logistic regression analysis (adjusted OR = 2.06; 95 % CI [1.02-4.18]; p = 0.044). Among ARDS CRF- patients, the presence of potentially reversible lung lesions with corticosteroids (aOR = 0.14; 95 % CI [0.03-0.62]) was associated with ICU survival.<bold>Conclusions: </bold>The absence of CRF among patients with ARDS is common and associated with a higher risk of mortality. For such atypical ARDS, a complete diagnostic workup, including bronchoalveolar lavage fluid cytology and chest CT scan patterns, should be performed to identify those patients who might benefit from specific therapies, including corticosteroids. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ADULT respiratory distress syndrome
*HISTOLOGY
*ARTIFICIAL respiration
*INTENSIVE care units
*BRONCHOALVEOLAR lavage
*ADULT respiratory distress syndrome treatment
*COMPARATIVE studies
*LONGITUDINAL method
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*EVALUATION research
*DISEASE prevalence
*RETROSPECTIVE studies
*DIAGNOSIS
Subjects
Details
- Language :
- English
- ISSN :
- 03424642
- Volume :
- 42
- Issue :
- 2
- Database :
- Academic Search Index
- Journal :
- Intensive Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 112462856
- Full Text :
- https://doi.org/10.1007/s00134-015-4064-y