title: Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition.
abstract: OBJECTIVE
  Some patients presenting with acute respiratory failure and meeting the Berlin criteria for acute respiratory distress syndrome (ARDS) lack exposure to common risk factors (CRF). These so-called ARDS mimickers often lack histological diffuse alveolar damage. We aimed to describe such ARDS mimickers lacking CRF (ARDS CRF-) in comparison with others (ARDS CRF+).
  
  
  METHODS
  Retrospective study including all patients receiving invasive mechanical ventilation for ARDS admitted to the intensive care units (ICUs) of two tertiary care centers from January 2003 to December 2012.
  
  
  RESULTS
  The prevalence of ARDS CRF- was 7.5 % (95 % CI [5.5-9.5]; n = 50/665). On the basis of medical history, bronchoalveolar lavage fluid cytology, and chest CT scan patterns, four etiological categories were identified: immune (n = 18; 36 %), drug-induced (n = 13; 26 %), malignant (n = 7; 14 %), and idiopathic (n = 12; 24 %). Although the ARDS CRF- patients had a lower logistic organ dysfunction score (4 [3-8] vs. 10 [6-13]; p < 0.0001) and less often shock upon ICU admission (44 vs. 80 %; p < 0.0001) than their counterparts, their overall ICU mortality rate was very high (66 % [46-74]), and the absence of CRF remained associated with ICU mortality by multivariable logistic regression analysis (adjusted OR = 2.06; 95 % CI [1.02-4.18]; p = 0.044). Among ARDS CRF- patients, the presence of potentially reversible lung lesions with corticosteroids (aOR = 0.14; 95 % CI [0.03-0.62]) was associated with ICU survival.
  
  
  CONCLUSIONS
  The absence of CRF among patients with ARDS is common and associated with a higher risk of mortality. For such atypical ARDS, a complete diagnostic workup, including bronchoalveolar lavage fluid cytology and chest CT scan patterns, should be performed to identify those patients who might benefit from specific therapies, including corticosteroids.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, 75970, Paris, France.|Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Gibelin
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, 75970, Paris, France.|Sorbonne Universités, UPMC Univ Paris 06, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.affiliation: Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Antenne de Pneumologie, 94010, Créteil, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
authors.affiliation: Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.|Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France.
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, 75970, Paris, France. muriel.fartoukh@tnn.aphp.fr.|Sorbonne Universités, UPMC Univ Paris 06, Paris, France. muriel.fartoukh@tnn.aphp.fr.|Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France. muriel.fartoukh@tnn.aphp.fr.
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
authors.affiliation: Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France. nicolas.de-prost@hmn.aphp.fr.|Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France. nicolas.de-prost@hmn.aphp.fr.
authors.forename: Nicolas
authors.identifier: http://orcid.org/0000-0002-4833-4320
authors.initials: N
authors.lastname: de Prost
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Idiopathic pulmonary fibrosis; Interstitial; Lung diseases; Pulmonary edema; Respiration, artificial; Respiratory distress syndrome, adult