0
Correspondence |

Outcomes in Patients With Acute Lung Injury/ARDS vs Cardiogenic Pulmonary EdemaOutcomes in ARDS vs Cardiogenic Pulmonary Edema FREE TO VIEW

Mohsin Ijaz, MD; Muhammad Adrish, MD
Author and Funding Information

From the Department of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine.

CORRESPONDENCE TO: Muhammad Adrish, MD, Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Ave, Ste 12 E, Bronx, NY 10457; e-mail: aadrish@hotmail.com


CONFLICT OF INTEREST: None declared.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(6):e194. doi:10.1378/chest.14-3052
Text Size: A A A
Published online
To the Editor:

It was with great interest that we read the retrospective study published by Schmickl et al1 in CHEST (March 2015) showing that in-hospital mortality was higher in patients admitted with acute lung injury (ALI)/ARDS compared with patients admitted with cardiogenic pulmonary edema (CPE). The study further showed that, despite the higher in-hospital mortality, long-term survival among the hospital survivors of the two groups was similar. However, some important concerns need to be addressed regarding these findings.

The goal of an observational study is to analyze the effect of an exposure. Yet, the apparent effect of the observed exposure could actually be the effect of another process, which could be unknown, unavailable, or unaccounted for in a retrospective analysis. ARDS is a deadly disease with very high mortality and morbidity. However, significant differences in mortality exist among the patients with ARDS when subclassified into mild, moderate, and severe form based on degree of hypoxemia. The authors reported very high in-hospital mortality in this cohort and cited studies to correspond with their mortality data that predate the lung protective ventilation era.2 It is noteworthy that information regarding how many patients received lung protective ventilation is lacking in this study. Contrary to current findings, another study reported predicted mortality of 27%, 32%, and 45% in the mild, moderate, and severe ARDS groups, respectively.3 Therefore, it is difficult to support the hypothesis that mortality in patients with ALI/ARDS and CPE is still high and did not change significantly over the past decade.

The ultimate purpose of clinical research is to improve health-care outcomes.4 In the Online First version of this article, Schmickl et al1 stated that long-term mortality was similar between the groups. Upon review of the study, it is noteworthy that 92% of patients in the ALI/ALI + CPE group compared with 53% of patients in the CPE group died during the long-term follow-up.1 Despite the fact that the mortality was not statistically different, the absolute difference in mortality between the two groups is substantial and, therefore, appears significant from a clinical point of view. While this is the first study, to our knowledge, that compared long-term outcomes between these two important groups of patients, the results need to be validated in a prospective study design with adequate power.

References

Schmickl CN, Biehl M, Wilson GA, Gajic O. Comparison of hospital mortality and long-term survival in patients with acute lung injury/ARDS vs cardiogenic pulmonary edema. Chest. 2015;147(3):618-625. [CrossRef] [PubMed]
 
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-1308. [CrossRef] [PubMed]
 
ARDS Definition Task Force,Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533. [PubMed]
 
Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ. Users’ guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group [published correction appears inJAMA. 1996;275(16):1232]. JAMA. 1995;274(22):1800-1804. [CrossRef] [PubMed]
 

Figures

Tables

References

Schmickl CN, Biehl M, Wilson GA, Gajic O. Comparison of hospital mortality and long-term survival in patients with acute lung injury/ARDS vs cardiogenic pulmonary edema. Chest. 2015;147(3):618-625. [CrossRef] [PubMed]
 
Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-1308. [CrossRef] [PubMed]
 
ARDS Definition Task Force,Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533. [PubMed]
 
Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ. Users’ guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group [published correction appears inJAMA. 1996;275(16):1232]. JAMA. 1995;274(22):1800-1804. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543