Towards prevention of acute lung injury: frequency and outcomes of emergency department patients at-risk - a multicenter cohort study.

Peter C Hou,Nina T Gentile,Aya Mitani,Ognjen Gajic,Gyorgy Frendl,Erica Y Kao,Marie-Carmelle Elie-Turenne,Jason E Cohen,Jonathan M Barry,

doi:10.1186/1865-1380-5-22

Abstract

BackgroundFew emergency department (ED) evaluations on acute lung injury (ALI) have been carried out; hence, we sought to describe a cohort of hospitalized ED patients at risk for ALI development.MethodsPatients presenting to the ED with at least one predisposing condition to ALI were included in this study, a subgroup analysis of a multicenter observational cohort study (USCIITG-LIPS 1). Patients who met ALI criteria within 6 h of initial ED assessment, received end-of-life care, or were readmitted during the study period were excluded. Primary outcome was frequency of ALI development; secondary outcomes were ICU and hospital mortality.ResultsTwenty-two hospitals enrolled 4,361 patients who were followed from the ED to hospital discharge. ALI developed in 303 (7.0 %) patients at a median onset of 2 days (IQR 2–5). Of the predisposing conditions, frequency of ALI development was highest in patients who had aortic surgery (43 %) and lowest in patients with pancreatitis (2.8 %). Compared to patients who did not develop ALI, those who did had higher ICU (24 % vs. 3.0 %, p < 0.001) and hospital (28 % vs. 4.6 %, p < 0.001) mortality, and longer hospital length of stay (16 vs. 5 days, p < 0.001). Among the 22 study sites, frequency of ALI development varied from less than 1 % to more than 12 % after adjustment for APACHE II.ConclusionsSeven percent of hospitalized ED patients with at least one predisposing condition developed ALI. The frequency of ALI development varied significantly according to predisposing conditions and across institutions. Further research is warranted to determine the factors contributing to ALI development.

Highlights

Few emergency department (ED) evaluations on acute lung injury (ALI) have been carried out; we sought to describe a cohort of hospitalized ED patients at risk for ALI development
Selection of participants Consecutive adult ED patients admitted to academic and community acute care hospitals were eligible for the study if they presented with one or more a priori defined conditions predisposing to ALI
ALI Developed within 48 H of Admission in At-Risk Patients and Markedly Increased Mortality ALI developed in 303 (7.0 %) admitted ED patients with a median of 2 days, inter-quartile range (IQR) 2–5 days

Summary

Introduction

Few emergency department (ED) evaluations on acute lung injury (ALI) have been carried out; we sought to describe a cohort of hospitalized ED patients at risk for ALI development. At the 1994 American–European Consensus Conference (AECC), experts agreed to the following terminology: Acute lung injury (ALI) was defined as the acute onset of hypoxemia [PaO2/FiO2 (partial pressure of arterial oxygen/fractional concentration of inspired oxygen) ≤ 300 mmHg] and bilateral infiltrates on frontal chest x-ray (Figure 1), in the clinical absence of left atrial hypertension (or when measured, pulmonary-artery wedge pressure < 18 mm Hg) [2]. Following the paradigm of trauma team care for major trauma, activation of the cardiac catheterization laboratory team for ST-elevation myocardial infarction and acute stroke teams for ischemic stroke, and early goal-directed therapy for severe sepsis, clinical benefit may be derived from early identification of and preventative interventions for patients at risk of developing ALI

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Discussion

Conclusion