Acute lung injury outside of the ICU: incidence in respiratory isolation on a general ward.
BACKGROUND
Epidemiologic investigations of acute lung injury (ALI) and ARDS have focused on mechanically ventilated patients in ICUs, and have reported high mortality rates. We sought to determine the incidence and lethality of these syndromes in the respiratory isolation areas of general wards, a non-ICU setting that often serves patients with acute lung processes.


METHODS
We prospectively studied all patients who were admitted to respiratory isolation rooms on the general wards of a large tertiary care hospital over a 1-year period. Patients were classified as having ALI or ARDS if they met consensus definitions for the syndromes. Characteristics and outcomes were compared to those of other patients who had been admitted to a respiratory isolation room with infiltrating lung disease but lacking bilateral infiltrates, hypoxemia, or both.


RESULTS
Of 715 patients admitted to respiratory isolation rooms on general wards, 474 (66%) had acute infiltrates. ALI criteria were met by 9% of patients (62 of 715 patients), with 2% of patients (15 of 715) satisfying the criteria for ARDS. Respiratory distress was present in 71% of ALI patients (44 of 62 patients) and 32% of patients (130 of 412 patients) with acute infiltrates who did not have ALI (p < 0.001). However, the 90-day survival rates (ALI patients, 88%; patients with acute infiltrates who did not have ALI, 90%) was similar between the two groups (p > 0.50).


CONCLUSIONS
ALI and ARDS may be frequent among patients who are admitted to respiratory isolation beds outside of ICUs. Mortality rates are substantially lower than those typically reported from surveys of ventilated ICU patients with ALI and ARDS.
Quartin
Andrew A
AA
Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL. Electronic address: aquartin@med.miami.edu.
Campos
Michael A
MA
Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL.
Maldonado
Diego A
DA
Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL.
Ashkin
David
D
Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL.
Cely
Cynthia M
CM
Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL.
Schein
Roland M H
RMH
Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL.
D055371:Acute Lung Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010356:Patient Isolation / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000628:therapy; D011024:Pneumonia, Viral / Q000453:epidemiology / Q000628:therapy; D011336:Probability; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D000900:Anti-Bacterial Agents