Citation

Erickson SE, Martin GS, Davis JL, Matthay MA, Eisner MD. Crit. Care Med. 2009; 37(5): 1574-1579.

Affiliation

Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Emory University, Atlanta, GA; and Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California.

Copyright

(Copyright © 2009, Society of Critical Care Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/CCM.0b013e31819fefdf

PMID

19325464

PMCID

PMC2696257

Abstract

OBJECTIVE:: Studies from single centers have suggested that mortality from acute lung injury (ALI) has declined over time. However, recent trends in ALI mortality from centers across the United States are unknown. Whether recent advances in the treatment of ALI or related critical illnesses have resulted in decreased mortality from ALI is not clear. METHODS:: In a study of 2,451 mechanically ventilated patients with ALI enrolled in the Acute Respiratory Distress Syndrome Network randomized controlled trials between 1996 and 2005, we evaluated whether there was a temporal improvement in 60-day mortality. We also investigated whether there were temporal improvements in mortality specific to individual causes of lung injury (pneumonia, sepsis, trauma, aspiration, and transfusion). RESULTS:: Crude mortality was 35% in 1996-1997 and declined during each subsequent time period to a low of 26% in 2004-2005 (test for trend p < 0.0005). After adjusting for demographic and clinical covariates, including receipt of lower tidal volume ventilation and severity of illness, the temporal trend persisted (test for trend p = 0.002). When analyzed by individual causes of lung injury, there were not any statistically significant temporal trends in 60-day mortality for the most common causes of lung injury (pneumonia, sepsis, aspiration, and trauma). CONCLUSIONS:: Over the past decade, there seems to be a clear temporal improvement in survival among patients with ALI treated at Acute Respiratory Distress Syndrome Network centers. Our findings strongly suggest that other advancements in critical care, aside from lower tidal volume ventilation, accounted for this improvement in mortality.

Language: en