Towards the prevention of acute lung injury: a population based cohort study protocol.
BACKGROUND
Acute lung injury (ALI) is an example of a critical care syndrome with limited treatment options once the condition is fully established. Despite improved understanding of pathophysiology of ALI, the clinical impact has been limited to improvements in supportive treatment. On the other hand, little has been done on the prevention of ALI. Olmsted County, MN, geographically isolated from other urban areas offers the opportunity to study clinical pathogenesis of ALI in a search for potential prevention targets.


METHODS
In this population-based observational cohort study, the investigators identify patients at high risk of ALI using the prediction model applied within the first six hours of hospital admission. Using a validated system-wide electronic surveillance, Olmsted County patients at risk are followed until ALI, death or hospital discharge. Detailed in-hospital (second hit) exposures and meaningful short and long term outcomes (quality-adjusted survival) are compared between ALI cases and high risk controls matched by age, gender and probability of developing ALI. Time sensitive biospecimens are collected for collaborative research studies. Nested case control comparison of 500 patients who developed ALI with 500 matched controls will provide an adequate power to determine significant differences in common hospital exposures and outcomes between the two groups.


CONCLUSIONS
This population-based observational cohort study will identify patients at high risk early in the course of disease, the burden of ALI in the community, and the potential targets for future prevention trials.
Thakur
Sweta J
SJ
Multidisciplinary Epidemiology and Translational Research in Intensive Care, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA. sweta2152002@yahoo.com
Trillo-Alvarez
Cesar A
CA
Malinchoc
Michael M
MM
Kashyap
Rahul
R
Thakur
Lokendra
L
Ahmed
Adil
A
Reriani
Martin K
MK
Cartin-Ceba
Rodrigo
R
Sloan
Jeff A
JA
Gajic
Ognjen
O
D055371:Acute Lung Injury / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D015331:Cohort Studies; D017281:Cost of Illness; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D008910:Minnesota; D019370:Observation; D018570:Risk Assessment; D055815:Young Adult