Epidemiology of Acute Lung Injury and Acute Respiratory Distress Syndrome

ABSTRACT

Acute respiratory distress syndrome (ARDS) is a heterogeneous disorder that may be triggered by myriad etiologies (both pulmonary and extrapulmonary). Mortality rates for ARDS range from 30 to 75%, and most deaths are a consequence of multiorgan failure (MOF). Since the sentinel description of ARDS in 1967, criteria for the diagnosis of this entity were refined. In 1992, diagnostic criteria for ARDS were published in an American-European Consensus Conference and the term acute lung injury (ALI) was adopted to encompass patients with a spectrum of less severe forms of the same pathological entity. This review discusses limitations of various criteria utilized to diagnosis ARDS and ALI, and why some criteria may be problematic when designing clinical trials. Also discussed are the myriad causes of ARDS, incidence, epidemiology, mortality, and factors that influence outcome.

KEYWORDS

Acute respiratory distress syndrome - acute lung injury - multiorgan failure - epidemiology - ventilator-associated lung injury

REFERENCES

• 1 Ashbaugh D G, Bigelow D B, Petty T L, Levine B E. Acute respiratory distress in adults.  Lancet. 1967;  2 319-323
• 2 Schuster D P. What is acute lung injury? What is ARDS?.  Chest. 1995;  107 1721-1726
• 3 Brochard L, Brun-Buisson C. Clinical trials in acute respiratory distress syndrome: what is ARDS?.  Crit Care Med. 1999;  27 1657-1658
• 4 Hudson L D, Milberg J A, Anardi D, Maunder R J. Clinical risks for development of the acute respiratory distress syndrome.  Am J Respir Crit Care Med. 1995;  151 293-301
• 5 Pittet J F, Mackersie R C, Martin T R, Matthay M A. Biological markers of acute lung injury: prognostic and pathogenetic significance.  Am J Respir Crit Care Med. 1997;  155 1187-1205
• 6 Lyons W S. Advancing the concept of two distinct ARDSs.  J Trauma. 2000;  48 188
• 7 Croce M A, Fabian T C, Davis K A, Gavin T J. Early and late acute respiratory distress syndrome: two distinct clinical entities.  J Trauma. 1999;  46 361-366
• 8 Gattinoni L, Bombino M, Pelosi P et al.. Lung structure and function in different stages of severe adult respiratory distress syndrome.  JAMA. 1994;  271 1772-1779
• 9 Esteban A, Anzueto A, Frutos F et al.. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.  JAMA. 2002;  287 345-355
• 10 Abraham E, Matthay M A, Dinarello C A et al.. Consensus conference definitions for sepsis, septic shock, acute lung injury, and acute respiratory distress syndrome: time for a reevaluation.  Crit Care Med. 2000;  28 232-235
• 11 Abraham E. Toward new definitions of acute respiratory distress syndrome.  Crit Care Med. 1999;  27 237-238
• 12 Ware L B, Matthay M A. The acute respiratory distress syndrome.  N Engl J Med. 2000;  342 1334-1349
• 13 Hudson L D, Steinberg K P. Epidemiology of acute lung injury and ARDS.  Chest. 1999;  116 74S-82S
• 14 Lesur O, Berthiaume Y, Blaise G et al.. Acute respiratory distress syndrome: 30 years later.  Can Respir J. 1999;  6 71-86
• 15 Bernard G R, Artigas A, Brigham K L et al.. The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination.  Am J Respir Crit Care Med. 1994;  149 818-824
• 16 Garber B G, Hebert P C, Yelle J D, Hodder R V, McGowan J. Adult respiratory distress syndrome: a systemic overview of incidence and risk factors.  Crit Care Med. 1996;  24 687-695
• 17 Moss M, Goodman P L, Heinig M, Barkin S, Ackerson L, Parsons P E. Establishing the relative accuracy of three new definitions of the adult respiratory distress syndrome.  Crit Care Med. 1995;  23 1629-1637
• 18 Murray J F, Matthay M A, Luce J M, Flick M R. An expanded definition of the adult respiratory distress syndrome.  Am Rev Respir Dis. 1988;  138 720-723
• 19 Lewandowski K, Metz J, Deutschmann C et al.. Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany.  Am J Respir Crit Care Med. 1995;  151 1121-1125
• 20 Amato M B, Barbas C S, Medeiros D M et al.. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.  N Engl J Med. 1998;  338 347-354
• 21 Brochard L, Roudot-Thoraval F, Roupie E et al.. Tidal volume reduction for prevention of ventilator-induced lung injury in acute respiratory distress syndrome. The Multicenter Trail Group on Tidal Volume reduction in ARDS.  Am J Respir Crit Care Med. 1998;  158 1831-1838
• 22 Luhr O R, Antonsen K, Karlsson M et al.. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.  Am J Respir Crit Care Med. 1999;  159 1849-1861
• 23 Roupie E, Lepage E, Wysocki M et al.. Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF Collaborative Group on Mechanical Ventilation. Societe de Reanimation de Langue Francaise.  Intensive Care Med. 1999;  25 920-929
• 24 Lewandowski K. Epidemiological data challenge ARDS/ALI definition.  Intensive Care Med. 1999;  25 884-886
• 25 Krafft P, Fridrich P, Pernerstorfer T et al.. The acute respiratory distress syndrome: definitions, severity and clinical outcome: an analysis of 101 clinical investigations.  Intensive Care Med. 1996;  22 519-529
• 26 Zilberberg M D, Epstein S K. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome.  Am J Respir Crit Care Med. 1998;  157 1159-1164
• 27 Doyle R L, Szaflarski N, Modin G W, Wiener-Kronish J P, Matthay M A. Identification of patients with acute lung injury: predictors of mortality.  Am J Respir Crit Care Med. 1995;  152 1818-1824
• 28 Rubenfeld G D, Caldwell E, Granton J T, Hudson L D, Matthay M A. Interobserver variability in applying a radiographic definition for ARDS.  Chest. 1999;  116 1347-1353
• 29 Meade M O, Cook R J, Guyatt G H et al.. Interobserver variation in interpreting chest radiographs for the diagnosis of acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2000;  161 85-90
• 30 Gowda M S, Klocke R A. Variability of indices of hypoxemia in adult respiratory distress syndrome.  Crit Care Med. 1997;  25 41-45
• 31 Ferguson N D, Kacmarek R M, Chiche J D et al.. Screening of ARDS patients using standardized ventilator settings: influence on enrolment in a clinical trial.  Intensive Care Med. 2004;  30 1111-1116
• 32 Meade M O, Guyatt G H, Cook R J et al.. Agreement between alternative classifications of acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2001;  163 490-493
• 33 Esteban A, Fernández-Segoviano P, Frutos-Vivar F et al.. Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings.  Ann Intern Med. 2004;  141 440-445
• 34 Ferguson N D, Frutos-Vivar F, Esteban A et al.. Acute respiratory distress syndrome: under-recognition by clinicians and diagnostic accuracy of three clinical definitions.  Crit Care Med. 2005;  33 2228-2234
• 35 Ferguson N D, Davis A M, Chan C K et al.. Development of a modified clinical definition of ARDS using the Delphi technique [abstract].  Am J Respir Crit Care Med. 2001;  163 A449
• 36 Arroliga A C, Ghamra Z W, Pérez-Trepichio A et al.. Incidence of ARDS in an adult population of Northeast Ohio.  Chest. 2002;  121 1972-1976
• 37 Bersten A D, Edibam C, Hunt T et al.. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states.  Am J Respir Crit Care Med. 2002;  165 443-448
• 38 Estenssoro E, Dubin A, Laffaire E et al.. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome.  Crit Care Med. 2002;  30 2450-2456
• 39 Stapleton R D, Wang B M, Hudson L D, Rubenfeld G D, Caldwell E S, Steinberg K P. Causes and timing of death in patients with ARDS.  Chest. 2005;  128 525-532
• 40 Ferguson N D, Frutos-Vivar F, Esteban A et al.. Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome.  Crit Care Med. 2005;  33 21-30
• 41 Rubenfeld G D, Caldwell E, Peabody E et al.. Incidence and outcomes of acute lung injury.  N Engl J Med. 2005;  353 1685-1693
• 42 Popovsky M A, Moore S B. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury.  Transfusion. 1985;  25 573-577
• 43 Silliman C C, Boshkov L K, Mehdizadehkashi Z et al.. Transfusion related acute lung injury: epidemiology and a prospective analysis of etiologic factors.  Blood. 2003;  101 454-462
• 44 Looney M, Gropper M, Matthay M. Transfusion related acute lung injury: a review.  Chest. 2004;  126 249-258
• 45 Toy P, Popovsky M, Abraham E, Ambruso D. The National Heart, Lung and Blood Institute Working Group on TRALI. Transfusion related acute lung injury: definition and review.  Crit Care Med. 2005;  33 721-726
• 46 Gajic O, Rana R, Mendez J L et al.. Acute lung injury after blood transfusion in mechanically ventilated patients.  Transfusion. 2004;  44 1468-1474
• 47 Shorr A F, Abbott K C, Agadoa L Y. Acute respiratory distress syndrome after kidney transplantation: epidemiology, risk factors, and outcomes.  Crit Care Med. 2003;  31 1325-1330
• 48 Lew T W, Kwek T K, Tai D et al.. Acute respiratory distress syndrome in critically ill patients with severe acute respiratory syndrome.  JAMA. 2003;  290 374-380
• 49 Dreyfuss D, Saunon G. Ventilator-induced lung injury: lessons from experimental studies.  Am J Respir Crit Care Med. 1998;  157 294-323
• 50 Gajic O, Dara S, Mendez J et al.. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation.  Crit Care Med. 2004;  32 1817-1824
• 51 Gajic O, Frutos-Vivar F, Esteban A, Hubmayr R D, Anzueto A. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients.  Intensive Care Med. 2005;  31 922-926
• 52 Matthay M A, Zimmerman G A, Esmon Ch et al.. Future research directions in acute lung injury: summary of a National Heart, Lung, and Blood Institute Working Group.  Am J Respir Crit Care Med. 2003;  167 1027-1035
• 53 Villar J, Slutsky A S. The incidence of the adult respiratory distress syndrome.  Am Rev Respir Dis. 1989;  140 814-816
• 54 Thomsen G E, Morris A H. Incidence of the adult respiratory distress syndrome in the State of Utah.  Am J Respir Crit Care Med. 1995;  152 965-971
• 55 Goss C H, Brower R G, Hudson L D et al.. Incidence of acute lung injury in the United States.  Crit Care Med. 2003;  31 1607-1611
• 56 Brun-Buisson C, Minelli C, Bertolini G et al.. Epidemiology and outcome of acute lung injury in European intensive care units: results from the ALIVE study.  Intensive Care Med. 2004;  30 51-61
• 57 Esteban A, Frutos-Vivar F, Ferguson N D et al.. Incidence, risk factor, and outcome of ALI/ARDS in a health area from Madrid, Spain [abstract].  Am J Respir Crit Care Med. 2004;  169 A780
• 58 Milberg J A, Davis D R, Steinberg K P, Hudson L D. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983-1993.  JAMA. 1995;  273 306-309
• 59 Abel S J, Finney S J, Brett S J, Keogh B F, Morgan C J, Evans T W. Reduced mortality in association with the acute respiratory distress syndrome (ARDS).  Thorax. 1998;  53 292-294
• 60 Montgomery A B, Stager M A, Carrico J et al.. Causes of mortality in patients with the adult respiratory distress syndrome.  Am Rev Respir Dis. 1985;  132 485-491
• 61 Ferring M, Vincent J L. Is outcome from ARDS related to the severity of respiratory failure?.  Eur Respir J. 1997;  10 1297-1300
• 62 Luhr O R, Karlsson M, Thorsteinsson A et al.. The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation.  Intensive Care Med. 2000;  26 508-517
• 63 Monchi M, Bellenfant F, Cariou A et al.. Early predictive factors of survival in the acute respiratory distress syndrome.  Am J Respir Crit Care Med. 1998;  158 1076-1081
• 64 Nuckton T J, Alonso J A, Kallet R H et al.. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome.  N Engl J Med. 2002;  346 1281-1286