Skip to main content
SpringerLink
Log in

Pronostic Factors and Outcome of ALI

  • Conference paper
Acute Lung Injury

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 30))

Abstract

The acute respiratory distress syndrome (ARDS) is an acute, severe alteration in lung structure and function characterized by hypoxemia, low-compliance lungs with a low funcional residual capacity, and diffuse radiographic infiltrates due to increased lung microvascular permeability [1]. Since first described in 1967 [2], the syndrome has been associated with a high mortality, and it is disappointing that despite many clinical and laboratory investigations the survival rates have remained virtually unchanged. Patients with the syndrome usually die either from the severity of lung impairment or from common complications. Whether the hypoxemia of acute respiratory failure is the usual cause of death in patients with ARDS is controversial. However, supportive measures such as mechanical ventilation with positive end-expiratory pressure (PEEP) [3] or extracorporeal membrane oxygenation [4,5], although technically successful at increasing arterial oxygenation, have had no obvious effect on reducing mortality. This suggests a need to focus on the prevention or treatment of other aspects of this syndrome, in addition to respiratory support measures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Loyd JE, Newman JH, Brigham KL (1984) Permeability pulmonary edema: Diagnosis and management. Arch Intern Med 144: 143 – 147

    Article  Google Scholar 

  2. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet 2: 319 – 323

    Article  PubMed  CAS  Google Scholar 

  3. Pepe PE, Hudson LD, Carrico CJ (1984) Early application of positive end-expiratory pressure in patients at risk for the adult respiratory distress syndrome. N Engl J Med 311: 281 – 286

    Article  PubMed  CAS  Google Scholar 

  4. Zapol WM, Snider MT, Hill JD, et al (1979) Extracorporeal membrane oxygenation in severe acute respiratory failure: A randomized prospective study. JAMA 242: 2193 – 2196

    Article  PubMed  CAS  Google Scholar 

  5. Morris AH, Wallace CJ, Menlove RL, Clemmer TP, Orme JF, Weaver LK, Dean NC, Thomas F, East TD, Pace NL, Suchyta MR, Beck E, Bombino M, Sitting DF, Böhm S, Hoffmann B, Becks H, Butler S, Pearl J, Rasmusson B. Randomized Clinical Trial of Pressure-controlled Inverse Ratio Ventilation and Extracorporeal C02 Renoval for Adult Respiratory Distress Syndrome. Am J Respir Crit Care Med 1994, 149: 295 – 305

    PubMed  CAS  Google Scholar 

  6. Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ (1982) Clinical predictors of the adult respiratory distress syndrome. Am J Surg 144: 124 – 130

    Article  PubMed  CAS  Google Scholar 

  7. Montgomery B, Stager MA, Carrico CJ, Hudson LD (1985) Causes of mortality in patients with the adult respiratory distress syndrome Am Rev Respir Dis 132: 485 – 489

    CAS  Google Scholar 

  8. Bell RC, Coalson JJ, Smith JD, Johanson WG (1983) Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 99: 293 – 298

    PubMed  CAS  Google Scholar 

  9. Fowler AA, Hamman RF, Good JT, et al (1983) Adult respiratory distress syndrome: Risk with common predisposition. Ann Intern Med 98: 593 – 597

    PubMed  CAS  Google Scholar 

  10. Milberg JA, Davis DR, Steinberg KP, Hudson LD (1995) Improved survival of patients with ARDS. 1983-1993. JAMA, 273: 306 - 309

    Article  PubMed  CAS  Google Scholar 

  11. Rinaldo JE (1986) The prognosis of the adult respiratory distress syndrome. Inappropriate pessimism? Chest 90: 470 – 471

    Article  PubMed  CAS  Google Scholar 

  12. Bernard GR, Artigas A, Brigham KL et al (1994). The American-European consensus conference on ARDS. Am J Respir Crit Care Med 149: 818 – 824

    PubMed  CAS  Google Scholar 

  13. Shuster DP (1995). What is acute lung injury? What is ARDS? Chest 107: 1721 – 1726

    Article  Google Scholar 

  14. Kollef MH, Shuster DP (1995). The acute respiratory distress syndrome. N Engl J Med 332: 27 – 37

    Article  PubMed  CAS  Google Scholar 

  15. Artigas A, Carlet J, Chastang C, Le Gall JR, Blanch L, Fernández R. Adult respiratory distress syndrome: clinical presentation, prognostic factors and outcome. In: Artigas A, Lemaire F, Suter PM, Zapol WM (eds) Adult respiratory distress syndrome. Churchill Livingstone, Edinburgh 1992, pp 509 – 525

    Google Scholar 

  16. Artigas A, Carlet J, Le Gall JR, Chastant C, Blanch L, Fernández R. Clinical presentation, prognostic factors and outcome of ARDS in the European Collaborative Study (1985-1987). In: Zapol W, Lemaire F (eds) Adult respiratory distress syndrome. Marcel Dekker. New York 1991, pp 37 – 63

    Google Scholar 

  17. Krafft P, Fridrich T, Pernerstorfer RD, Fitzgerald D et al (1996) The acute respiratory distress syndrome: definitions, severity and clinical outcome. An analysis of 101 clinical investigations. Intensive Care Med 22: 519 – 529

    Article  PubMed  CAS  Google Scholar 

  18. Anzueto A, Baughman R, Guntapalli K et al (1996) Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. N Engl J Med 334: 1417 – 1421

    Article  PubMed  CAS  Google Scholar 

  19. Brochard L, Roudot-Thoraval F, and the collaborative group on Vt reduction (1997) Tidal volume (Vt) reduction in acute respiratory distress syndrome (ARDS): a multicenter randomized study. Am J Respir Crit Care 155: A505

    Google Scholar 

  20. Stewart E, Meade M, Granton et al (1997) Pressure and volume limited ventilation strategy (PLUS) in patients at high risk for ARDS: Results of a multicenter trial. Am J Respir Crit Care 155: A505.

    Google Scholar 

  21. Hudson LD, Milberg JA, Anardi D, Maunder RJ (1995) Clinical risks for development of the acute respiratory distress syndrome. Am J Respir Crit Care 151: 293 – 301

    CAS  Google Scholar 

  22. Fowler AA, Hamman RF, Zerbe GO, Benson KN, Hyers TM (1985) Adult respiratory distress syndrome: Prognosis after onset. Am Rev Respir Dis 132: 472 – 478

    PubMed  CAS  Google Scholar 

  23. Artigas A, Mancebo J (1987) Etiology and multiple organ system failure as prognostic factors in ARDS. In: Vincent JL (ed) Update in Intensive Care and Emergency Medicine. Springer-Verlag, Berlin, pp 163 – 169

    Google Scholar 

  24. Mancebo J, Artigas A (1987) A clinical study of the adult respiratory distress syndrome Crit Care Med 15: 243 - 246

    CAS  Google Scholar 

  25. Bone RC, Balk R, Slotman G, Maunder R, Silverman H, Hyers TM, Kerstein MD (1992) Adult Respiratory Distress Syndrome: Sequence and importance of development of multiple organ failure. Chest 101: 320 – 326

    Article  PubMed  CAS  Google Scholar 

  26. Bone RC, Maunder R, Slotman G, Silverman H, Hyers TM, Kerstein MD, Ursprung JJ (1989) An early test of survival in patients with the adult respiratory distress syndrome. The Pa02/FI02 ratio and its differential response to conventional therapy. Chest 96: 849 – 851

    Article  PubMed  CAS  Google Scholar 

  27. Artigas A, Lemeshow S, Rue M, Avrunin J, Mestre J, Le Gall JR and ICU Scoring Group (1994) Risk stratification and outcome assessment of patients with acute lung injury. Am J Respir Crit Care Med 149: Al029

    Google Scholar 

  28. De Latorre FJ, Estopa R, Artigas A (1983) Intercambio gaseoso como factor pronóstico en el síndrome de distress respiratorio del adulto. Med Intensiva 7: 1 – 6

    Google Scholar 

  29. Lamy M, Fallai RJ, Koeniger E, et al (1976) Pathologie features and mechanisms of hypoxemia in adult respiratory distress syndrome. Am Rev Respir Dis 114: 267 – 284

    PubMed  CAS  Google Scholar 

  30. National Heart, Lung and Blood Institute, Division of Lung Diseases (1979) Extracorporeal Support for Respiratory Insufficiency: A Collaborative Study. Bethesda, MD, NIH

    Google Scholar 

  31. Barlett RH, Morris AH, Fairley BF, Hirsh R, O’Connor N, Pontoppidan H (1986) A prospective study of acute hypoxic respiratory failure. Chest 89: 684 – 689

    Article  Google Scholar 

  32. Fein AM, Lippmann M, Holtzman H, Eliraz A, Goldberg SK (1983) The risk factors, incidence, and prognosis of ARDS following septicemia. Chest 83: 40 – 42

    Article  PubMed  CAS  Google Scholar 

  33. Kaplan RL, Sahn SA, Petty TL (1979) Incidence and outcome of the respiratory distress syndrome in Gram-negative sepsis. Arch Intern Med 139: 867 – 869

    Article  PubMed  CAS  Google Scholar 

  34. Idell S, Cohen AB (1983) Bronchoalveolar lavage in patients with the adult respiratory distress syndrome. Clin Chest Med 6: 459 – 71

    Google Scholar 

  35. Bachofen M, Weibel ER (1982) Structural alterations of lung parenchyma in the adult respiratory distress syndrome. Clin Chest Med 3: 35 – 56

    PubMed  CAS  Google Scholar 

  36. Holter JF, Weiland JE, Patch ER, Gadek JE, Davis WB (1986) Protein permeability in the adult respiratory distress syndrome. Loss of size selectivity of alveolar epithelium. J Clin Invest 78: 1513 – 22.

    Article  PubMed  CAS  Google Scholar 

  37. Sprung CL, Long WM, Marciai EH et al (1987) Distribution of proteins in pulmonary edema. The value of fractional concentrations. Am Rev Respir Dis 136: 957 – 63

    PubMed  CAS  Google Scholar 

  38. Fowler AA, Hyers TM, Fisher BJ, Bechard DE, Centor RM, Webster RO (1987) The adult respiratory distress syndrome cell populations and soluble mediators in the air spaces of patients at high risk. Am Rev Respir Dis 136: 1225 – 31

    PubMed  CAS  Google Scholar 

  39. Weiland JE, Davis WB, Holter JF, Mohammed JR, Dorinsky PM, Gadek JE (1986) Lung neutrophils in the adult respiratory distress syndrome: clinical and pathophysiologic significance. Am Rev Respir Dis 133: 218 – 25

    PubMed  CAS  Google Scholar 

  40. Martin TR, Pistorese BP, Hudson LD, Maunder RJ (1991) The function of lung and blood neutrophils in patients with the adult respiratory distress syndrome: implications for the pathogenesis of lung infections. Am Rev Respir Dis 144: 254 – 62

    PubMed  CAS  Google Scholar 

  41. Repine JE, Beehler CJ (1991) Neutrophils and adult respiratory distress syndrome: two interlocking perspectives in 1991. Am Rev Respir Dis 144: 251 – 2

    PubMed  CAS  Google Scholar 

  42. Suter PM, Suter S, Girardin E, Roux Lombard P, Grau GE, Dayer JM. High broncho alveolar levels of tumor necrosis factor and its inhibitors, interleukin-1, interferon, and elastase, in patients with respiratory distress syndrome after trauma, shock, or sepsis. Am Rev Respir Dis 145:1016–22

    Google Scholar 

  43. Lee CT, Fein AM, Lippman M, Holtzman H, Kimbel P, Weinbaum G (1981) Elastalytic activity in pulmonary lavage fluid from patients with the adult respiratory distress syndrome. N Engl J Med 304: 192 – 196

    Article  PubMed  CAS  Google Scholar 

  44. Shasby DM, Fox RB, Harada RN, Repine JE (1982) Reduction of the edema of acute hyperoxic lung injury by granulocyte deplation. J Appi Physiol 52: 1237 – 1244.

    CAS  Google Scholar 

  45. Steinberg KP, Milberg JA, Martin TR, Maunder RJ, Cockrill BA, Hudson LD (1994) Evolution of bronchoalveolar cell populations in the respiratory distress syndrome. Am J Respir Crit Care Med 150: 113 – 122

    PubMed  CAS  Google Scholar 

  46. Goodman RB, Strieter RM, Martin DP, et al (1996) Inflammatory cytokines in patients with persistence of the acute respiratory distress syndrome. Am J Respir Crit Care Med 154: 602 – 611

    PubMed  CAS  Google Scholar 

  47. Artigas A, Fontcuberta J, Castella J, Rutllant M (1985) Coagulation disorders in the adult respiratory distress syndrome. In: Vincent JL (ed) Update in Intensive Care and Emergency Medicine. Springer-Verlag, Berlin, pp 84 – 89

    Google Scholar 

  48. Fontcuberta J, Artigas A, Sala N, et al (1986) Inhibitors of blood coagulation in adult respiratory distress syndrome. Intensive Care Med 12: 224 (Abst)

    Google Scholar 

  49. Zapol WM, Frikker MJ, Pontoppidan H, Wilson RS, Lynch KE (1991) The adult respiratory distress syndrome at Massachusetts General Hospital: Etiology, progression and survival rates 1978–1988. In: Adult respiratory distress syndrome. De. WM Zapol, F Lemaire. Marcel Dekker, New York, pp 367 – 380

    Google Scholar 

  50. Bartlett RH, Gazzaniga AB, Wilson AF, Medley T, Wetmore N (1975) Mortality prediction in adult respiratory insufficiency. Chest 6: 680 – 684

    Article  Google Scholar 

  51. Shimada Y, Yoshiya I, Tanaka K, Sone S, Sakurai M (1979) Evaluation of the progress and prognosis of adult respiratory distress syndrome. Chest 76: 180 – 186

    Article  PubMed  CAS  Google Scholar 

  52. Jardin F, Prost JF, Bazin M, Desfond P, Ozier Y, Margairez A (1982) Modalités évolutives du syndrome de détresse respiratoire aigüe de l’adulte: Valeur pronostique d’un indice de gravité tiré de I’oxygenation arterielle. Nouv Press Med 11: 29 – 33

    CAS  Google Scholar 

  53. Smith PEM, Gordon IJ (1986) An index to predict outcome in adult respiratory distress syndrome. Intensive Care Med 12: 86 – 89

    Article  PubMed  CAS  Google Scholar 

  54. Hickling KG, Henderson SJ, Jackson R (1990) Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med 16: 372 – 377

    Article  PubMed  CAS  Google Scholar 

  55. Hickling KG, Walsh J, Henderson S, Jackson R (1994) Low mortality rate in adult respiratory distress syndrome using low–volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med 22: 1568 – 1578

    Article  PubMed  CAS  Google Scholar 

  56. Morel D, Dargent F, Bachmann M, Suter PM, Junot AF (1985) Pulmonary extraction of serotonin and propanolol in patients with ARDS. Am Rev Respir Dis 132: 479 – 484

    PubMed  CAS  Google Scholar 

  57. Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome Am Rev Respir Dis 138: 720 – 723

    CAS  Google Scholar 

  58. Schuster DP (1992) Prediction outcome after ICU admission: The art and science of assessing risk. Chest 102: 1861

    Article  PubMed  CAS  Google Scholar 

  59. Lemeshow S, Le Gall JR (1994) Modeling the severity of illness of ICU patients: a system update. JAMA 272: 1049 – 1055

    Article  PubMed  CAS  Google Scholar 

  60. Lemeshow S, Teres D, Klar J et al (1993) Mortality probability models (MPM II) based on an international cohort of intensive care unit patients. JAMA 270: 2478 – 2486

    Article  PubMed  CAS  Google Scholar 

  61. Le Gall JR, Lemeshow S, Saulnier F et al (1993) A new simplified acute physiology score (SAPS II) based on an European/North American multicenter study. JAMA 270: 2957 – 2963

    Article  PubMed  Google Scholar 

  62. Knauss WA, Wagner DP, Drapper ET et al (1991) The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100: 1619 – 1636

    Article  Google Scholar 

  63. Lemeshow S, Klar J, Teres D et al (1994) Mortality probability models for patients in the intensive care unit for 48 or 72 hours: A prospective, multicenter study. Crit Care Med 22: 1351 – 1358

    Article  PubMed  CAS  Google Scholar 

  64. Le Gall JR, Loirat P, Alperovitch A et al (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12: 975 – 977

    Article  PubMed  Google Scholar 

  65. Knaus WA, Zimmerman JE, Wagner DP et al (1981) APACHE - Acute physiology and chronic health evaluation: A physiologically based classification system. Crit Care Med 9: 591 – 597

    Article  PubMed  CAS  Google Scholar 

  66. Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: A severity of disease classification system. Crit Care Med 13: 818 – 829

    Article  PubMed  CAS  Google Scholar 

  67. Knaus WA, Sun X, Hakim RB, Wagner DP (1994) Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care 150: 311 – 317

    CAS  Google Scholar 

  68. Le Gall JR, Brun-Buisson C, Trunet P, et al (1982) Influence of age, previous health status and severity of illness on outcome from intensive care. Crit Care Med 10: 575 – 577

    Article  PubMed  Google Scholar 

Download references

Authors
  1. A. Artigas
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Pulmonary and Critical Care, St. Paul Ramsey Medical Center, 640 Jackson Street, St. Paul, 55101, MN, USA

    John J. Marini

  2. Anaesthesia and Critical Care, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK

    Timothy W. Evans

Rights and permissions

Reprints and permissions

Copyright information

© 1998 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Artigas, A. (1998). Pronostic Factors and Outcome of ALI. In: Marini, J.J., Evans, T.W. (eds) Acute Lung Injury. Update in Intensive Care and Emergency Medicine, vol 30. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-60733-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-60733-2_2

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64532-7

  • Online ISBN: 978-3-642-60733-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation