Acute respiratory distress syndrome (ARDS) is an important complication of acute illness and injury. Over the past decade the survival of ARDS has improved and it may now be possible for a patient to have more than one episode of ARDS in a lifetime. The characteristics of such may point to specific environmental or genetic factors important in the development of this complication. Preliminary data suggested that gastroesophageal reflux disease (GERD) and chronic pain managed with opioids may contribute to recurrent ARDS. In order to determine risk factors for recurrent ARDS, we performed this study.
In a population based cohort study, patients were identified from electronic medical records based on the American European Consensus Conference definition. Adult ( > 18 years old) patients who experienced two or more episodes of ARDS were included into analysis. Risk factors were evaluated, including the history of GERD and chronic pain, and were recorded.
Nineteen patients presented with recurrent ARDS over a 10 year period (1999–2009) from Olmsted County, MN. The average age of patients in the study was 64.9 (SD 18.3), and 11 out of 19 (57.9%) of them were women. Sepsis was the most common predisposing condition (78%). Fifteen of the 19 patients (78.9%) were found to have GERD treated with chronic acid suppression. Four of the 19 patients (21.1%) were found to have chronic pain. Median time to second episode was 264 (IQR 80 –460) days. Nine of 19 patients died during the second episode (47.4%). Overall, 17 out of 19 patients had died by the time of this study (89.4%). Median survival after second episode was 22 (IQR 4 –371) days.
Recurrent ARDS carries a poor prognosis. GERD, and specifically the use of chronic acid suppression, predisposes patients to develop recurrent ARDS.
Future work should evaluate the presence of GERD in patients with ARDS. This could lead to better understanding of pathophysiology as well as potential for prevention of ARDS.
Thomas Bice, No Financial Disclosure Information; No Product/Research Disclosure Information