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Original Research: CRITICAL CARE MEDICINE |

Acute Lung Injury Outside of the ICU: Incidence in Respiratory Isolation on a General Ward

Andrew A. Quartin, MD, MPH; Michael A. Campos, MD; Diego A. Maldonado, MD; David Ashkin, MD; Cynthia M. Cely, MD; Roland M. H. Schein, MD
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, FL.

Correspondence to: Andrew Quartin, MD, MPH, Critical Care Medicine (111), Miami VAMC, 1201 NW Sixteenth St, Miami, FL 33125; e-mail: aquartin@med.miami.edu


No external funding was received for this study.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

For editorial comment see page 251


Chest. 2009;135(2):261-268. doi:10.1378/chest.08-0280
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Background:  Epidemiologic investigations of acute lung injury (ALI) and ARDS have focused on mechanically ventilated patients in ICUs, and have reported high mortality rates. We sought to determine the incidence and lethality of these syndromes in the respiratory isolation areas of general wards, a non-ICU setting that often serves patients with acute lung processes.

Methods:  We prospectively studied all patients who were admitted to respiratory isolation rooms on the general wards of a large tertiary care hospital over a 1-year period. Patients were classified as having ALI or ARDS if they met consensus definitions for the syndromes. Characteristics and outcomes were compared to those of other patients who had been admitted to a respiratory isolation room with infiltrating lung disease but lacking bilateral infiltrates, hypoxemia, or both.

Results:  Of 715 patients admitted to respiratory isolation rooms on general wards, 474 (66%) had acute infiltrates. ALI criteria were met by 9% of patients (62 of 715 patients), with 2% of patients (15 of 715) satisfying the criteria for ARDS. Respiratory distress was present in 71% of ALI patients (44 of 62 patients) and 32% of patients (130 of 412 patients) with acute infiltrates who did not have ALI (p < 0.001). However, the 90-day survival rates (ALI patients, 88%; patients with acute infiltrates who did not have ALI, 90%) was similar between the two groups (p > 0.50).

Conclusions:  ALI and ARDS may be frequent among patients who are admitted to respiratory isolation beds outside of ICUs. Mortality rates are substantially lower than those typically reported from surveys of ventilated ICU patients with ALI and ARDS.

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