Incidence and outcomes of acute lung injury in thesurgical intensive care unit of a tertiary care hospital inBangkok, Thailand

Abstract

Background: Although the pathophysiology and treatment of acute lung injury (ALI) and acute respiratorydistress syndrome (ARDS) are well established, the incidence and outcomes of ALI have not been extensivelyreported. Variations in healthcare systems, demographics, socioeconomics, and levels of intensive care units(ICU) may explain remarkable differences in outcomes reported.Objectives: To evaluate the incidence and outcomes of ALI/ARDS at the surgical ICU (SICU) at Siriraj Hospitalof Mahidol University, Bangkok.Methods: We included patients aged ≥18 years admitted to the general SICU between June 1, 2010 and May 31, 2013 in this prospective, cohort observational study. All patients required ≥24 h of ventilatory support.The study outcomes were the incidence of ALI/ARDS, SICU length of stay, and mortality rate.Results: Of 2523 patients admitted to the SICU, 495 (20%) required ≥24 h ventilatory support, and 15 (3%)developed ALI/ARDS. ALI/ARDS occurred on day 2 of ventilatory support. ARDS was caused by sepsis andpneumonia. The patients who developed ALI/ARDS had a higher APACHE II score (P = 0.001) and end-stagerenal disease (P = 0.01). Pneumonia and acute kidney injury were more severe in patients with ALI and ARDS(40% vs 9%, P = 0.002; 33% vs 10%, P = 0.02, respectively). Ventilatory support duration, SICU lengths of stayand hospital mortality were higher in the ALI/ARDS group.Conclusions: The incidence of ALI/ARDS in the SICU was low, but the mortality rate was high. A larger samplesize is necessary to identify independent risk factors for ALI/ARDS.