The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis.

MedStar author(s):
Citation: Shock. 40(5):375-81, 2013 Nov.PMID: 23903852Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal Article | Observational Study | Research Support, N.I.H., ExtramuralSubject headings: *Emergency Service, Hospital/sn [Statistics & Numerical Data] | *Respiratory Distress Syndrome, Adult/ep [Epidemiology] | *Sepsis/ep [Epidemiology] | Aged | APACHE | Biological Markers/bl [Blood] | Female | Hospital Mortality | Humans | Incidence | Lactic Acid/bl [Blood] | Male | Middle Aged | Pennsylvania/ep [Epidemiology] | Respiration, Artificial | Respiratory Distress Syndrome, Adult/et [Etiology] | Respiratory Distress Syndrome, Adult/th [Therapy] | Retrospective Studies | Risk Assessment/mt [Methods] | Sepsis/co [Complications]Local holdings: Available online through MWHC library: 2002 - presentISSN:
  • 1073-2322
Name of journal: Shock (Augusta, Ga.)Abstract: BACKGROUND: Acute respiratory distress syndrome (ARDS) is a serious complication of sepsis, and sepsis-associated ARDS is associated with significant morbidity and mortality. To date, no study has directly examined the epidemiology of ARDS in severe sepsis from the earliest presentation to the health care system, the emergency department (ED).CONCLUSIONS: In patients presenting to the ED with severe sepsis, the rate of sepsis-associated ARDS development varied across the continuum of care. Acute respiratory distress syndrome developed rapidly and was associated with significant mortality. Elevated serum lactate levels in the ED and a recently validated clinical prediction score were independently associated with the development of ARDS in severe sepsis.METHODS: This was a single-center retrospective, observational cohort study of 778 adults with severe sepsis presenting to the ED. The primary outcome was the development of ARDS requiring mechanical ventilation during the first 5 hospital days. Acute respiratory distress syndrome was defined using the Berlin definition. We used multivariable logistic regression to identify risk factors associated independently with ARDS development.RESULTS: The incidence of ARDS was 6.2% (48/778 patients) in the entire cohort. Acute respiratory distress syndrome development varied across the continuum of care: 0.9% of patients fulfilled criteria for ARDS in the ED, 1.4% admitted to the ward developed ARDS, and 8.9% admitted to the intensive care unit developed ARDS. Acute respiratory distress syndrome developed a median of 1 day after admission and was associated with a 4-fold higher risk of in-hospital mortality (14% vs. 60%, P < 0.001). Independent risk factors associated with increased risk of ARDS development included intermediate (2-3.9 mmol/L) (P = 0.04) and high (>4) serum lactate levels (P = 0.008), Lung Injury Prediction score (P < 0.001), and microbiologically proven infection (P = 0.01).All authors: Bellamy SL, Christie JD, Fuchs BD, Gaieski DF, Goyal M, Lyon S, Meyer NJ, Mikkelsen ME, Miltiades AN, Shah CVDigital Object Identifier: Date added to catalog: 2014-08-21
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 23903852

Available online through MWHC library: 2002 - present

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a serious complication of sepsis, and sepsis-associated ARDS is associated with significant morbidity and mortality. To date, no study has directly examined the epidemiology of ARDS in severe sepsis from the earliest presentation to the health care system, the emergency department (ED).

CONCLUSIONS: In patients presenting to the ED with severe sepsis, the rate of sepsis-associated ARDS development varied across the continuum of care. Acute respiratory distress syndrome developed rapidly and was associated with significant mortality. Elevated serum lactate levels in the ED and a recently validated clinical prediction score were independently associated with the development of ARDS in severe sepsis.

METHODS: This was a single-center retrospective, observational cohort study of 778 adults with severe sepsis presenting to the ED. The primary outcome was the development of ARDS requiring mechanical ventilation during the first 5 hospital days. Acute respiratory distress syndrome was defined using the Berlin definition. We used multivariable logistic regression to identify risk factors associated independently with ARDS development.

RESULTS: The incidence of ARDS was 6.2% (48/778 patients) in the entire cohort. Acute respiratory distress syndrome development varied across the continuum of care: 0.9% of patients fulfilled criteria for ARDS in the ED, 1.4% admitted to the ward developed ARDS, and 8.9% admitted to the intensive care unit developed ARDS. Acute respiratory distress syndrome developed a median of 1 day after admission and was associated with a 4-fold higher risk of in-hospital mortality (14% vs. 60%, P < 0.001). Independent risk factors associated with increased risk of ARDS development included intermediate (2-3.9 mmol/L) (P = 0.04) and high (>4) serum lactate levels (P = 0.008), Lung Injury Prediction score (P < 0.001), and microbiologically proven infection (P = 0.01).

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