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Journal Title:

Critical Care Nursing Quarterly


Volume 13, Number 5


Lippincott, Williams and Wilkins: No Hybrid Open Access | 2009-01-01, Pages R150-R150

Type of Work:

Article | Final Publisher PDF

Abstract: Introduction: Sepsis-induced acute lung injury ALI has been reported to have a higher case fatality rate than other causes of ALI. However, differences in the severity of illness in septic vs. non-septic ALI patients might explain this finding.Methods: 520 patients enrolled in the Improving Care of ALI Patients Study ICAP were prospectively characterized as having sepsis or non sepsis-induced ALI. Biologically plausible risk factors for in-hospital death were considered in multiple logistic regression models to evaluate the independent association of sepsis vs. non-sepsis ALI risk factors with mortality.Results: Patients with sepsis-induced ALI had greater illness severity and organ dysfunction APACHE II and SOFA scores at ALI diagnosis and higher crude in-hospital mortality rates compared with non-sepsis ALI patients. Patients with sepsis-induced ALI received similar tidal volumes, but higher levels of positive end expiratory pressure, and had a more positive net fluid balance in the first week after ALI diagnosis. In multivariable analysis, the following variables odds ratio, 95% confidence interval were significantly associated with hospital mortality: age 1.04, 1.02 to 1.05, admission to a medical intensive care unit ICU 2.76, 1.42 to 5.36, ICU length of stay prior to ALI diagnosis 1.15, 1.03 to 1.29, APACHE II 1.05, 1.02 to 1.08, SOFA at ALI diagnosis 1.17, 1.09 to 1.25, Lung Injury Score 2.33, 1.74 to 3.12 and net fluid balance in liters in the first week after ALI diagnosis 1.06, 1.03 to 1.09. Sepsis did not have a significant, independent association with mortality 1.02, 0.59 to 1.76.Conclusions: Greater severity of illness contributes to the higher case fatality rate observed in sepsis-induced ALI. Sepsis was not independently associated with mortality in our study.

Subjects: Health Sciences, Immunology - Health Sciences, General - Research Funding: JES is supported by K-23 GMO7-1399-01A1. DMN is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research CIHR. This research was supported by a NHBLI SCCOR grant in Acute Lung Injury SCCOR grant P050 HL 73994.

This research was supported by a NHBLI SCCOR grant in Acute Lung Injury SCCOR grant P050 HL 73994.

Keywords: Science and Technology - Life Sciences and Biomedicine - Critical Care Medicine - General and Internal Medicine - CRITICAL CARE MEDICINE - RESPIRATORY-DISTRESS-SYNDROME - POSITIVE FLUID BALANCE - OUTCOMES -

Autor: Jonathan Sevransky, Gregory Martin, Carl Shanholtz, Pedro A. Mendez-Tellez, Peter Pronovost, Roy Brower, Dale M. Needham,



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