title: Clinical characteristics and outcomes of patients with acute lung injury and ARDS.
abstract: BACKGROUND
  Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical illnesses associated with significant morbidity and mortality.
  
  
  OBJECTIVE
  This was designed to assess various etiologies of ALI/ARDS, to determine the correlation between the diagnostic criteria and need of mechanical ventilation, and to correlate biochemical factors with the outcome of patients.
  
  
  METHODS
  An observational, prospective study was conducted in a medical intensive care unit (MICU) of a tertiary care hospital, for a period of 1 year.
  
  
  METHODS
  This study encompassed 58 consecutive cases of ALI/ARDS admitted to a MICU as per AECC guidelines. Patients excluded were with cardiac failure, chronic kidney diseases with fluid overload, and age below 12 years.
  
  
  METHODS
  The data were analysed applying χ2 -test, multivariate logistic regression analysis of significance, using computer-based program SPSS.
  
  
  RESULTS
  There were more males (74%) than females, and presentation was more common in the younger age group, with a total mortality of 57%. Factors attributable for ALI/ARDS were malaria in 16 patients (27.6%), leptospirosis in 12 (20.7%), malaria with dengue in 3 (5.2%), undiagnosed fever in 16 (27.6%), pneumonia in 8 (13.8%), urinary tract infection in 2 (3.4%), and pancreatitis in 1 (1.7%) patient. Out of 41 patients with PaO 2 /FiO 2 <200, 40 patients required invasive ventilation, and out of 17 patients with PaO 2 /FiO 2 >200, 11 patients though initially managed on noninvasive ventilation (NIV) subsequently required invasive ventilation, and remaining six were successfully managed on NIV. Out of 41 patients requiring mechanical ventilation, 36 had LIS >2.5, whereas only 3 out of 17 patients with LIS <2.5 required mechanical ventilation.
  
  
  CONCLUSIONS
  Malaria, leptospirosis, and undiagnosed fever were the main etiologies followed by pneumonia, urinary tract infections, and pancreatitis. Both the PaO 2 /FiO 2 ratio and lung injury score (LIS) at the time of admission were significant predictors of the outcome and of necessity of mechanical ventilation. PaO 2 /FiO 2 was a better predictor of duration of stay at the intensive care unit than the LIS. Sepsis, acidosis, hypotension, and multiorgan failure were individual predictors of mortality in patients with ALI/ARDS while age, sex, anemia, thrombocytopenia, renal failure, hepatic failure, and X-ray picture were not predictors of the outcome.
authors: Department of Medicine, Topiwala National Medical College and B.Y.L. Nair CH. Hospital, Mumbai Central, Mumbai, Maharashtra, India. rakeshbhadade@gmail.com
authors: R R
authors: RR
authors: Bhadade
authors: R A
authors: RA
authors: de Souza
authors: M J
authors: MJ
authors: Harde
authors: A
authors: A
authors: Khot
mesh_terms: D000138:Acidosis / Q000150:complications; D055371:Acute Lung Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D003715:Dengue / Q000150:complications; D005260:Female; D005335:Fever of Unknown Origin / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D007922:Leptospirosis / Q000150:complications; D008288:Malaria / Q000150:complications; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications; D010195:Pancreatitis / Q000150:complications; D011014:Pneumonia / Q000150:complications; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018805:Sepsis / Q000150:complications; D012720:Severity of Illness Index; D014552:Urinary Tract Infections / Q000150:complications