Abstract
Background. Lung injury prediction score (LIPS) is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS). This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. Methods. IRB approved, prospective observational study including all ventilated patients admitted to the surgical intensive care unit at a single tertiary center over 6 months. ARDS was defined using the Berlin criteria. LIPS were calculated for all patients and analyzed. Logistic regression models evaluated the ability of LIPS to predict development of ARDS and mortality. A receiver operator characteristic (ROC) curve demonstrated the optimal LIPS value to statistically predict development of ARDS. Results. 268 ventilated patients were observed; 141 developed ARDS and 127 did not. The average LIPS for patients who developed ARDS was 8.8 ± 2.8 versus 5.4 ± 2.8 for those who did not (p < 0.001). An ROC area under the curve of 0.79 demonstrates LIPS is statistically powerful for predicting ARDS development. Furthermore, for every 1-unit increase in LIPS, the odds of developing ARDS increase by 1.50 (p < 0.001) and odds of ICU mortality increase by 1.22 (p < 0.001). Conclusion. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients.
Highlights
Mechanical ventilation is one of the most common treatment modalities utilized in the intensive care unit (ICU) regardless of the admission reason [1]
Much of this lung injury can be attributed to the use of higher tidal volumes [1, 3] as demonstrated by work done by the Acute Respiratory Distress Syndrome Network in 2000 [4]
Our study has shown that Lung injury prediction score (LIPS) is a consistent and valid method for predicting the development of acute respiratory distress syndrome (ARDS) and mortality in ventilated surgical critical care patients
Summary
Mechanical ventilation is one of the most common treatment modalities utilized in the intensive care unit (ICU) regardless of the admission reason [1]. Up to 25% of patients with normal lungs will develop some level of acute respiratory distress syndrome (ARDS) when placed on mechanical ventilation [2]. Extensive free radical production overwhelms endogenous antioxidants and causes oxidative cell damage [8] Factors such as endothelin-1, angiotensin-2, NF-kappa B, and phospholipase A-2 increase vascular permeability and destroy microvascular architecture, enhancing inflammation and lung damage [8]. The increase of alveolar fluid decreases gas exchange across the alveolar-capillary membrane resulting in hypoxemia and respiratory failure This further leads to generation of reactive oxygen species [9] and activation of the coagulation cascade [10] promoting. Lung injury prediction score (LIPS) is valuable for early recognition of ventilated patients at high risk for developing acute respiratory distress syndrome (ARDS). This study analyzes the value of LIPS in predicting ARDS and mortality among ventilated surgical patients. LIPS is reliable for predicting development of ARDS and predicting mortality in critically ill surgical patients
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