Elsevier

Clinics in Chest Medicine

Volume 21, Issue 3, 1 September 2000, Pages 401-417
Clinics in Chest Medicine

ACUTE LUNG INJURY AND ACUTE RESPIRATORY DISTRESS SYNDROME: The Clinical Syndrome

https://doi.org/10.1016/S0272-5231(05)70156-8Get rights and content

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DEFINITIONS

Acute lung injury (ALI) refers to a syndrome of severe, acute respiratory failure characterized by respiratory distress, a severe impairment of oxygenation, and noncardiogenic pulmonary edema. Because ALI, like any other clinical syndrome, can vary in severity, acute respiratory distress syndrome (ARDS) is a term applied to patients with more severe manifestations of ALI. Both terms are used to reflect a relatively specific form of pathologic injury to the lung occurring from a wide range of

INCIDENCE

The incidences of ARDS and ALI are not clear. A National Institutes of Health panel in 1972 estimated the incidence of ARDS to be 150,000 cases a year in the United States, an incidence of approximately 75 cases/100,000 population/year.35 This number has been widely used since that time, without confirmation from epidemiologic studies. Some prospective studies have found a much lower incidence of ARDS, ranging from 1.5 to 8.4 cases/100,000 population/year.5, 6, 7 The methodology to perform an

RISK FACTORS

Clinical risk factors are either conditions associated with ARDS or markers that occur in conditions known to be associated with ARDS. The data on risk factors have been generated primarily for ARDS so this discussion reflects that limitation. These associated conditions can be categorized mechanistically as causing either direct (primary) or indirect (secondary) injury—that is, a result of extrapulmonary illness or injury that injures the lungs through activation of systemic inflammation,

CLINICAL MANIFESTATIONS

ALI and ARDS occur in the setting of acute, severe illness. Clinical manifestations of the patient with ALI or ARDS reflect the underlying illnesses, the severe pulmonary injury, or the multiple organ failure that may co-exist. The clinical manifestations can range widely, depending on the underlying disease process and the number and type of organs that are failing in addition to the lungs. Pulmonary inflammation with alveolar flooding and surfactant depletion result in intrapulmonary

Mortality

Factors associated with mortality include risk factors and age. Sepsis as a risk for ARDS generally is associated with a considerably higher mortality rate than most other common risks, including trauma and aspiration of gastric contents.21 Older patients, often studied as patients greater than 65 years of age, have an increased mortality rate compared with younger patients as determined in several studies.4, 21, 47, 48 None of these studies considered co-morbidities in a multivariant analysis,

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    Address reprint requests to Kenneth P. Steinberg, MD, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, Box 359762, 325 Ninth Avenue, Seattle, WA 98104, e-mail: [email protected]

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