Acute respiratory distress syndrome natural history, complications, and prognosis: Difference between revisions
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{{Acute respiratory distress syndrome}} | {{Acute respiratory distress syndrome}} | ||
{{CMG}}, {{AE}} {{BShaller}} | {{CMG}}, {{AE}} {{BShaller}} | ||
==Overview== | ==Overview== | ||
ARDS | If left untreated, 70% of patients with ARDS may progress to [[mortality]].<ref name="pmid11056707">{{cite journal| author=Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y| title=Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. | journal=Crit Care | year= 1998 | volume= 2 | issue= 1 | pages= 29-34 | pmid=11056707 | doi=10.1186/cc121 | pmc=28999 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11056707 }} </ref> Common complications to ARDS include [[weakness]], impaired [[spirometry|lung function]], and [[brain death]]. Prognosis for patients with ARDS is generally poor and varies based on the severity of illness, the precipitating insult, and medical comorbidities. | ||
==Natural History== | ==Natural History== | ||
If left untreated, 70% of patients with ARDS may progress to [[mortality]].<ref name="pmid11056707">{{cite journal| author=Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y| title=Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. | journal=Crit Care | year= 1998 | volume= 2 | issue= 1 | pages= 29-34 | pmid=11056707 | doi=10.1186/cc121 | pmc=28999 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11056707 }} </ref> | |||
==Complications== | ==Complications== | ||
Complications of ARDS are common and more likely to develop among patients who do not receive early or adequate treatment. They include: | |||
*Significant [[weakness]] due to [[muscle atrophy|critical illness myoneuropathy and muscle atrophy]] as a result of long-term immobilization | *Significant [[weakness]] due to [[muscle atrophy|critical illness myoneuropathy and muscle atrophy]] as a result of long-term immobilization | ||
*Impaired [[Spirometry|lung function]] | *Impaired [[Spirometry|lung function]] | ||
*Chronic [[Mechanical ventilation|ventilator dependency]] due to advanced weakness and [[atrophy]] of the [[muscles of respiration]] | *Chronic [[Mechanical ventilation|ventilator dependency]] due to advanced weakness and [[atrophy]] of the [[muscles of respiration]] | ||
*[[Fibrotic lung disease|Pulmonary fibrosis]] and [[restrictive lung disease]] | *[[Fibrotic lung disease|Pulmonary fibrosis]] and [[restrictive lung disease]] | ||
*[[Psychiatric illness]] | *[[Psychiatric illness]], including [[post-traumatic stress disorder]] (PTSD), [[anxiety]], and [[depression]] | ||
*Impaired [[cognition]] | *Impaired [[cognition]] | ||
*[[Persistent vegetative state]] or [[brain death]] due to prolonged hypoxemia | *[[Persistent vegetative state]] or [[brain death]] due to prolonged [[hypoxemia]] | ||
Common complications of ARDS associated with a prolonged [[ICU]] stay include: | |||
*[[Nosocomial infection|Secondary or nosocomial infections]] (e.g., [[hospital-acquired pneumonia|ventilator-associated pneumonia]] | *[[Nosocomial infection|Secondary or nosocomial infections]] (e.g., [[hospital-acquired pneumonia|ventilator-associated pneumonia]] (VAP) or [[Intravascular device related infections|central line-associated blood stream infection]] (CLABSI)) | ||
*[[Venous thromboembolism|Venous thromboembolic events]] (e.g., [[deep vein thrombosis]] | *[[Venous thromboembolism|Venous thromboembolic events]] (e.g., [[deep vein thrombosis]] (DVT) or [[pulmonary embolism]] (PE)) | ||
*[[GI bleed|Gastrointestinal bleeding]] (often secondary to [[Stress ulcer|stress ulcers]]) | *[[GI bleed|Gastrointestinal bleeding]] (often secondary to [[Stress ulcer|stress ulcers]]) | ||
*[[Pressure ulcers]] and poor [[wound healing]] | *[[Pressure ulcers]] and poor [[wound healing]] | ||
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==Prognosis== | ==Prognosis== | ||
Prognosis for patients with ARDS varies based on the | Prognosis for patients with ARDS is generally poor and varies based on the severity of illness, the precipitating insult, and medical comorbidities:<ref name="pmid11056707">{{cite journal| author=Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y| title=Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base. | journal=Crit Care | year= 1998 | volume= 2 | issue= 1 | pages= 29-34 | pmid=11056707 | doi=10.1186/cc121 | pmc=28999 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11056707 }} </ref><ref name="pmid22797452">{{cite journal| author=ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E et al.| title=Acute respiratory distress syndrome: the Berlin Definition. | journal=JAMA | year= 2012 | volume= 307 | issue= 23 | pages= 2526-33 | pmid=22797452 | doi=10.1001/jama.2012.5669 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22797452 }} </ref><ref name="pmid12594312">{{cite journal| author=Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F et al.| title=One-year outcomes in survivors of the acute respiratory distress syndrome. | journal=N Engl J Med | year= 2003 | volume= 348 | issue= 8 | pages= 683-93 | pmid=12594312 | doi=10.1056/NEJMoa022450 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12594312 }} </ref><ref name="pmid20384998">{{cite journal| author=Linko R, Suojaranta-Ylinen R, Karlsson S, Ruokonen E, Varpula T, Pettilä V et al.| title=One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure. | journal=Crit Care | year= 2010 | volume= 14 | issue= 2 | pages= R60 | pmid=20384998 | doi=10.1186/cc8957 | pmc=2887181 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20384998 }} </ref><ref name="pmid24435201">{{cite journal| author=Wang CY, Calfee CS, Paul DW, Janz DR, May AK, Zhuo H et al.| title=One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome. | journal=Intensive Care Med | year= 2014 | volume= 40 | issue= 3 | pages= 388-96 | pmid=24435201 | doi=10.1007/s00134-013-3186-3 | pmc=3943651 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24435201 }} </ref><ref name="pmid20507948">{{cite journal| author=Sheu CC, Gong MN, Zhai R, Chen F, Bajwa EK, Clardy PF et al.| title=Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS. | journal=Chest | year= 2010 | volume= 138 | issue= 3 | pages= 559-67 | pmid=20507948 | doi=10.1378/chest.09-2933 | pmc=2940067 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20507948 }} </ref> | ||
*90-day morality rates for mild, moderate, and severe ARDS as 27%, 32%, and 45%, respectively | |||
*1-year mortality rate for patients with ARDS who survive to hospital discharge varies widely and is estimated to be beween 11% to over 40% | |||
*Between 1992-1995, an in-hospital mortality rate between 36%-52% | |||
*Lower mortality rate among patients with ARDS due to [[trauma]] compared patients with ARDS due to [[sepsis]] | |||
==References== | ==References== | ||
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[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:FinalQCRequired]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Brian Shaller, M.D. [2]
Overview
If left untreated, 70% of patients with ARDS may progress to mortality.[1] Common complications to ARDS include weakness, impaired lung function, and brain death. Prognosis for patients with ARDS is generally poor and varies based on the severity of illness, the precipitating insult, and medical comorbidities.
Natural History
If left untreated, 70% of patients with ARDS may progress to mortality.[1]
Complications
Complications of ARDS are common and more likely to develop among patients who do not receive early or adequate treatment. They include:
- Significant weakness due to critical illness myoneuropathy and muscle atrophy as a result of long-term immobilization
- Impaired lung function
- Chronic ventilator dependency due to advanced weakness and atrophy of the muscles of respiration
- Pulmonary fibrosis and restrictive lung disease
- Psychiatric illness, including post-traumatic stress disorder (PTSD), anxiety, and depression
- Impaired cognition
- Persistent vegetative state or brain death due to prolonged hypoxemia
Common complications of ARDS associated with a prolonged ICU stay include:
- Secondary or nosocomial infections (e.g., ventilator-associated pneumonia (VAP) or central line-associated blood stream infection (CLABSI))
- Venous thromboembolic events (e.g., deep vein thrombosis (DVT) or pulmonary embolism (PE))
- Gastrointestinal bleeding (often secondary to stress ulcers)
- Pressure ulcers and poor wound healing
- Muscle wasting and atrophy
Prognosis
Prognosis for patients with ARDS is generally poor and varies based on the severity of illness, the precipitating insult, and medical comorbidities:[1][2][3][4][5][6]
- 90-day morality rates for mild, moderate, and severe ARDS as 27%, 32%, and 45%, respectively
- 1-year mortality rate for patients with ARDS who survive to hospital discharge varies widely and is estimated to be beween 11% to over 40%
- Between 1992-1995, an in-hospital mortality rate between 36%-52%
- Lower mortality rate among patients with ARDS due to trauma compared patients with ARDS due to sepsis
References
- ↑ 1.0 1.1 1.2 Reynolds HN, McCunn M, Borg U, Habashi N, Cottingham C, Bar-Lavi Y (1998). "Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base". Crit Care. 2 (1): 29–34. doi:10.1186/cc121. PMC 28999. PMID 11056707.
- ↑ ARDS Definition Task Force. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E; et al. (2012). "Acute respiratory distress syndrome: the Berlin Definition". JAMA. 307 (23): 2526–33. doi:10.1001/jama.2012.5669. PMID 22797452.
- ↑ Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F; et al. (2003). "One-year outcomes in survivors of the acute respiratory distress syndrome". N Engl J Med. 348 (8): 683–93. doi:10.1056/NEJMoa022450. PMID 12594312.
- ↑ Linko R, Suojaranta-Ylinen R, Karlsson S, Ruokonen E, Varpula T, Pettilä V; et al. (2010). "One-year mortality, quality of life and predicted life-time cost-utility in critically ill patients with acute respiratory failure". Crit Care. 14 (2): R60. doi:10.1186/cc8957. PMC 2887181. PMID 20384998.
- ↑ Wang CY, Calfee CS, Paul DW, Janz DR, May AK, Zhuo H; et al. (2014). "One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome". Intensive Care Med. 40 (3): 388–96. doi:10.1007/s00134-013-3186-3. PMC 3943651. PMID 24435201.
- ↑ Sheu CC, Gong MN, Zhai R, Chen F, Bajwa EK, Clardy PF; et al. (2010). "Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS". Chest. 138 (3): 559–67. doi:10.1378/chest.09-2933. PMC 2940067. PMID 20507948.