title: Six-month survival of patients with acute lung injury: prospective cohort study.
abstract: OBJECTIVE
  Both short- and long-term outcome studies in acute lung injury (ALI) performed thus far were conducted before the implementation of recent advances in mechanical ventilation and supportive care and/or in the context of clinical trials with restricted inclusion criteria. We sought to determine the outcome of consecutive acute lung injury patients after the implementation of these interventions.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Three intensive care units of two tertiary care hospitals.
  
  
  METHODS
  Patients with acute lung injury treated from October 2005 to May 2006, excluding those with no research authorization or do-not-resuscitate order.
  
  
  METHODS
  None.
  
  
  RESULTS
  The investigators collected detailed information about comorbidities, severity of pulmonary and nonpulmonary organ failures, complications, respiratory support, and other interventions. The main outcome measure was mortality 6 months after the onset of acute lung injury. From 142 patients enrolled over a 6-month period, 24 (17%) died in the intensive care unit, 38 (27%) in the hospital, and 55 (39%) by the end of the 6-month follow-up. Median (interquartile range) intensive care unit length of stay, duration of mechanical ventilation, and number of day 28 ventilator-free days were 7.1 (3.6-11.3), 5.7 (2.6-10.3), and, 19.0 (0-24.2) days. Multiple logistic regression analysis identified underlying Charlson comorbidity score (odds ratio 3.11, 95% confidence interval 2.01-5.05) for each point increase, transfer admission from the floor or outside hospital (odds ratio 3.75, 95% confidence interval 1.41-10.99), day 3 cardiovascular failure (odds ratio 3.30, 95% confidence interval 1.19-9.92), and day 3 Pao2/Fio2 (odds ratio 0.94, 95% confidence interval 0.88-0.99) as significant predictors of 6-month mortality.
  
  
  CONCLUSIONS
  With the implementation of recent advances in mechanical ventilation and supportive care, premorbid condition is the most important determinant of acute lung injury survival.
authors.affiliation: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Murat
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Remzi
authors.initials: R
authors.lastname: Iscimen
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Vlahakis
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Hubmayr
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D045169:Severe Acute Respiratory Syndrome / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D013997:Time Factors