大剂量氨茶碱治疗急性肺损伤疗效观察

急性肺损伤 ( AL I)是指由心源性以外的各种肺内外致病因素导致的急性、进行性缺氧性呼吸衰竭。AL I和急性呼吸窘迫综合征 ( ARDS)具有性质相同的病理生理改变 ,AL I若得不到及时有效的控制可发展为 ARDS。因此 ,必须积极采取措施阻断 AL I向 ARDS发展。 2 0 0 0年 2月～ 2 0 0 1年 10月 ,我院采用大剂量氨茶碱治疗 AL I5 4例 ,取得满意的疗效 ,现将结果报告如下。资料与方法 :根据 1999年全国呼吸衰竭学术会议制定的AL I/ ARDS诊断标准 ,选择 AL I患者 10 8例 ,男 61例、女 47例 ,年龄 16～ 78岁、平均 3 9.8岁。随机分为两…     

重症急性胰腺炎非手术治疗的临床护理路径研究

目的探讨非手术治疗的临床护理路径(CNP)在重症急性胰腺炎(SAP)中的应用价值。方法纳入80例SAP患者作为研究对象,随机分为两组,各40例。其中观察组40例行CNP护理方案,对照组40例行常规护理方案。比较两组患者住院时间、恢复工作时间及医疗费用。记录两组患者急性生理学及慢性健康状况系统(APACHEⅡ)评分、患者满意度、住院期间并发症发生情况。结果观察组住院时间、恢复工作时间及医疗费用均显著低于对照组(P0.05)。观察组出院时APACHEⅡ评分显著低于对照组,满意度显著优于对照组(P0.05)。观察组住院期间并发症总发生率显著低于对照组(P0.05)。结论 CNP用于SAP能显著缩短患者康复时间,减少并发症,改善预后,且能显著降低医疗费用,有助于提高患者满意度。     

进一步提高急性呼吸窘迫综合征的诊治策略

急性呼吸窘迫综合征 (Acuterespiratorydistresssyndrome ,ARDS)是由多种因素引起的急性进行性非心源性肺水肿和低氧血症综合征 ,是急性肺损伤(ALI)的严重阶段。在加强医疗病房 (ICU )中是一种常见的重症患者 ,费用大 ,病死率高。 1972年美国国立卫究院 (NIH)的报告 ,美国每年约有 15万患者发生ARDS ,年发病率为 6 5 / 10万。ARDS的病死率介于 10 %～ 90 %之间。近几年病死率虽有下降 ,病死率大约 4 0 %左右 ,仍然提示ARDS的发病率和病死率很高 ,其主要原因是ALI/ARDS诊断和治疗的认识不够。ARDS的诊断2 0 0 0年中华医学会呼…     

持续静滴山莨菪碱治疗重症急性胰腺炎——60例病例对照研究

目的　探讨持续静滴山莨菪碱治疗重症急性胰腺炎 (SAP)的价值。方法　将 6 0例住院收治 SAP,随机分为治疗组 (n=31)及标准对照组 (n=2 9) ,(治疗组每日山莨菪碱 4 0 ～ 10 0 mg,对照组常规使用奥曲肽 /思他宁 0 .2 5 mg/ h) ,比较两组病例的平均腹痛缓解天数、治愈所需住院天数、病死率及平均住院医疗费用。结果　治疗组平均腹痛缓解天数 2 .1d,平均住院天数 14 .7d,病死率 0 (0 / 31) ,平均住院医疗费用 5 797元 ;标准对照组平均腹痛缓解天数 6 .2 9d,平均住院天数 33.4 d,病死率 14 .0 %(4 / 2 9) ,平均住院医疗费用 2 184 4元。两组在平均腹痛缓解天数 (t=7.90 ,P<0 .0 0 1)、住院天数 (t=4 .19,P<0 .0 0 1)及住院费用 (t=2 .90 ,P<0 .0 1)上的比较均有显著统计学差异 ,病死率亦有显著性差异(χ2 =4 .5 8,P<0 .0 5 )。结论　内科治疗 SAP时 ,在常规治疗基础上 ,持续静滴山莨菪碱 ,可及时控制或减少并发症 ,显著缩短病程及住院天数 ,显著降低病死率及医疗费用。     

P27在急性白血病患者中表达的研究

目的 :研究细胞周期蛋白依赖激酶抑制物P2 7在急性白血病 (AL)患者中的表达 ,探讨P2 7在AL中的作用机制及其临床意义。方法 :应用免疫细胞化学链霉素抗生物素蛋白 过氧化酶 (SP)法检测AL患者 4 3例及对照组 10例P2 7的表达 ,并用蛋白印迹 (Western blot) [DAB(3,3’二氨基联苯胺 )显色与化学发光显示 ]法检测其中 11例AL患者及 10例对照P2 7的表达。结果 :SP法显示 4 3例AL患者P2 7阳性表达率 (18.6 0 % )明显低于对照组 (80 % ) (P <0 .0 5 )。急性淋巴细胞白血病 (ALL)患者阳性表达率 (2 2 .73% ) ,急性非淋巴细胞白血病(ANLL)患者 (14 .2 9% )均低于对照组 (均P <0 .0 5 )。但两者间差异无统计学意义 (P >0 .0 5 ) ;未缓解组P2 7阳性表达率较缓解组患者低 ,但两者间差异无统计学意义。蛋白印迹法也同样提示AL患者P2 7呈低表达。结论 :P2 7在AL患者中有异常低表达 ,但未显示与缓解相关性。P2 7在AL中是否具有抑癌基因的作用 ,有待进一步研究。     

急性白血病抗血管新生治疗中的护理

为探讨抑制血管新生在治疗急性白血病 (AL)中的护理方法 ,将 2 7例初治患者随机分为常规化疗组(B组 )及联用反应停组 (A组 )两组。 11例复治患者 (C组 )均联用化疗药物及反应停。用 因子相关抗原和 CD3 4单抗免疫组化染色的方法 ,观察患者治疗前后骨髓微血管密度 (MVD)。用 EL ISA的方法测定患者治疗前后血清血管内皮细胞生长因子 (VEGF)的浓度。反应停剂量 2 0 0～ 5 0 0 mg/ d,连用 4～ 6个月。结果两组初治病例的疗效无差异 ,复治组 CR率 2 7.2 7% ,A、B两组 CR患者随访 6个月 ,A组复发率较低。患者 MVD、VEGF治疗前与对照组 (15例健康体检正常者 )相比 ,差异非常显著 (P<0 .0 0 1)     

急性白血病/骨髓增生异常综合征患者DNA甲基转移酶亚型的表达

目的　探讨DNA甲基转移酶 (DNMTs)亚型与急性白血病 (AL)发病及骨髓增生异常综合征 (MDS)向AL转化的关系。方法　半定量逆转录 (RT) PCR技术测定 75例AL/MDS患者的DNMT1、3A及 3B的mRNA表达水平。结果　低危MDS组 (2 1例 )DNMT各亚型的表达升高与正常对照组平均值无统计学差异 ,但以正常对照组平均值的 80 %单侧上界为界 ,则分别为 4 7 6 %、4 7 6 %和 4 2 9% ,高于正常对照 (P <0 0 1)。高危MDS组 (13例 )分别为 5 3 8%、76 9%和 92 3%高于正常对照 (P <0 0 1) ,其中DNMT 3B表达显著高于低危MDS组 (P <0 0 1) ,而DNMT1和 3A表达与低危组差异无显著性。AL组 (41例 )DNMT1、3A及 3B分别为 92 7%、97 6 %和 10 0 %高于正常对照 (P <0 0 1) ,且三种DNMT亚型表达水平均显著高于MDS组 (P <0 0 1)。急性淋巴细胞白血病组DNMT1表达显著高于急性髓细胞白血病组 (P <0 0 1) ,而二组的DNMT3A ,3B表达无统计学差异。结论　DNMTs表达水平的增高与AL的发病及MDS向AL转化过程密切相关 ,并以DNMT3B的关系最为密切。     

食管癌术后急性呼吸窘迫综合征8例临床分析

食管癌术后并发急性呼吸窘迫综合征 (ARDS)是危及生命的严重并发症 ,死亡率高。1992年 1月至 2 0 0 3年 3月 ,我科共行食管癌根治术 90 3例 ,术后并发 ARDS8例。现报告并分析如下。临床资料 :本组均为男性 ,年龄 5 2～ 72 (平均 6 2 .4 )岁 ,体重 5 4～ 6 7(平均 6 1) kg。癌肿位于上段 2例 ,中段 6例。 6例有慢性阻塞性肺病 (COPD)病史 ;均有吸烟史 ,平均 30支 / d,烟龄 2 0年以上。肺功能检查示 ,实测值 /预计值最大通气量(MVV) 5 0 %～ 76 % ,用力肺活量 (FVC) 5 3%～ 80 % ,第 1秒用力呼气量 (FEV1 ) 5 2 %～ 85 %。均行手术治…     

急性呼吸窘迫综合征病死危险因素分析

目的 :探讨急性呼吸窘迫综合征 (ARDS)病死率居高不下因素。方法 :收集 1年 8个月中因ARDS收入ICU所有患者的临床资料 (原发病或诱发因素、APACHEⅡ评分、严重程度、机械通气治疗和PEEP水平、糖皮质激素 ) ,分析各种特定危险因素与病死率之间关系 ,χ2 检验差异显著性。结果 :4 4例中 ,年龄 5～ 84岁 (5 4 .5± 2 1.5 )岁 ;肺内组病死率 93.3% (14 /15例 ) ,肺外组 4 4 .8% (13/2 9例 ) ,肺内组高于肺外组 (P <0 .0 1) ;APACHEⅡ评分≤ 2 0分组病死率低于≥ 31分组 (P <0 .0 5 ) ;以PaO2 /FiO2 和 Qs/ QT判断严重程度 ,对预后无显著影响 (P >0 .0 5 ) ;PEEP水平 6～ 10cmH2 O组病死率低于≥ 11cmH2 O组 (P <0 .0 5 ) ;机械通气治疗组病死率明显低于未接受机械通气治疗组 ,P <0 .0 5 ;34例接受不同类型激素治疗病死率 (70 .6 % )高于未接受激素治疗组 (30 .0 % ) ,差异显著 (P <0 .0 1) ,应用时间与剂量间无显著差异 (P >0 .0 5 ) ;直接死亡原因为ARDS未得到纠正者仅占 11.1% (3/2 7例 ) ,明显低于感染性休克和MODS(P <0 .0 1)。结论 :在及时应用机械通气治疗前提下 ,肺内疾病和APACHEⅡ评分≥ 31可能是预报ARDS病死率高的指标。     

临床护理路径在晚期血吸虫病巨脾型患者标准化管理中的应用

目的 目的 研究晚期血吸虫病巨脾型患者临床护理路径标准化管理的可行性及实施效果。方法 方法 将64例晚期血吸虫病巨脾型患者随机分为常规护理组 （对照组） 和临床护理路径组 （CNP组）, 分析比较2组患者术后情况、 平均住院日、 住院费用及满意率的区别。结果 结果 实施临床护理路径后, 晚期血吸虫病巨脾型患者的术后并发症、 平均住院日、 住院费用较对照组明显减少, 患者满意度从81.25%上升至100%。结论 结论 在晚期血吸虫病巨脾型患者治疗中实施CNP标准化管理有效降低了患者住院天数、 费用和并发症的发生, 提高了患者满意率。     

小潮气量通气对ALI/ARDS高风险患者疗效及预后的影响分析

目的研究机械通气治疗的急性肺损伤/急性呼吸窘迫综合症(ALI/ARDS)高风险患者,应用小潮气量通气对患者疗效和预后的影响。方法采用随机数字表法将本院重症监护病房(ICU)收治的56例ALI/ARDS高风险患者分为研究组和对照组各28例,研究组采用小潮气量(VT6~8ml/kg)通气治疗,对照组采用常规潮气量(VT10~12ml/kg)通气治疗,比较两组患者治疗后不同时间的血气指标、血清炎症变化及预后差异。结果通气48h、通气96h后两组患者的Pa O2、Pa CO2、氧饱和度、p H值、氧合指数、中心静脉压均较通气即刻显著好转(P0.05)。通气48h、通气96h后两组患者的血清IL-6、TNF-ɑ、CRP水平均较通气即刻显著的降低(P0.05),研究组在通气48h、通气96h后血清IL-6、TNF-ɑ、CRP水平均显著的低于对照组(P0.05)。研究组的ALI/ARDS发病率(14.29%)、ICU治疗时间(9.5±2.6)d、机械通气治疗时间(7.4±1.3)d、住院时间(13.7±3.2)d、死亡率(10.71%),均显著的低于对照组患者(P0.05)。结论 ALI/ARDS高风险患者应用小潮气量机械通气治疗,较常规潮气量通气治疗具有更好的临床效果,预后效果更好。     

Statins for the prevention and treatment of acute lung injury and acute respiratory distress syndrome: A systematic review and meta‐analysis

The purpose of this meta‐analysis was to assess whether statins could reduce the morbidity of acute lung injury and acute respiratory distress syndrome (ALI/ARDS) in high‐risk patients and improve the clinical outcomes of patients with ALI/ARDS. Studies were obtained from PubMed, Medline, Embase and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) and cohort studies, which reported morbidity, mortality, ventilator‐free days, length of stay in intensive care unit and hospital or oxygenation index, were included in our meta‐analysis. Risk ratio (RR) and weighted mean difference (WMD) were calculated using fixed or random effect model. A total of 13 studies covering 12 145 patients were included. Both the only RCT (P = 0.10) and cohort studies (RR, 1.02; 95% CI, 0.67 to 1.55; P = 0.94) showed that statin therapy did not lower the morbidity of ALI/ARDS in high‐risk patients. The mortality of ALI/ARDS patients was less likely to be improved by statins (RCT, RR, 1.00; 95% CI, 0.84 to 1.20; P = 0.97; cohort studies, RR, 1.04; 95% CI, 0.85 to 1.27; P = 0.72). Moreover, no significant difference was observed in ventilator‐free days, length of stay in intensive care unit as well as hospital and oxygenation index. This meta‐analysis suggests that statins neither provide benefit for lowering the morbidity of ALI/ARDS in high‐risk patients nor improve the clinical outcomes of ALI/ARDS patients. Hence, it may not be appropriate to advocate statin use for the prevention and treatment of ALI/ARDS.     

外科重症监护病房非心脏术后患者急性肺损伤/急性呼吸窘迫综合征特点及影响预后的多因素分析

目的回顾分析外科重症监护病房（SICU）非心脏术后住院患者的临床资料,以观察非心脏手术后患者急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）的发病情况及预后影响因素。方法2006年9月至2007年8月连续收入解放军总医院外科重症监护病房的105名非心脏手术术后患者纳入本研究。其中男62名,女43名;年龄（51.0±18.1）岁。沿用中华医学会重症医学分会（2006年）提出的ALI/ARDS诊断标准,所有观察病例按照入住SICU期间的最低氧合指数水平分为3组：氧合指数正常组,ALI组,ARDS组。分别比较各病例组年龄,体重,体重指数,ICU停留时间,以及患者住ICU期间以及转出ICU后30d内患者总死亡率,术中出血量与输液量。并应用Logistic回归分析以上各因素对ALI/ARDS患者总死亡率的影响。结果3组患者间年龄、体重和体重指数比较有显著性统计差异,发生ARDS组患者体重最重,体重指数最高。ARDS组在ICU停留时间明显高于其他2组。3组患者总死亡率无显著统计差异。各组患者中,术中出血量和液体入量无显著差异。Logistic回归分析显示,在发生ALI/ARDS的SICU患者中,年龄是影响患者预后的独立因素。高龄ALI/ARDS患者更容易发生死亡。结论老年、体重较重的患者更容易在术后发生ALI/ARDS,应加强此类高危患者的围术期管理,从而降低外科术后ALI/ARDS发病率,减少发病患者的死亡率。     

Inter-observer variability in chest radiograph reading for diagnosing acute lung injury in children

Acute lung injury (ALI), including its most serious form called acute respiratory distress syndrome (ARDS), is a devastating disease that can occur at any age. ALI/ARDS accounts for only 5-8% of admissions to pediatric intensive care units (PICUs) but is fatal in 30-60% of cases. International multicenter prospective studies are needed to better understand pediatric ALI/ARDS. However, a reproducible definition of ALI/ARDS is crucial to ensure that study populations are homogeneous. We designed a retrospective review to test the inter-observer variability of chest radiograph interpretation for presence of the American-European Consensus Conference (AECC) radiographic criterion for ALI/ARDS. The medical files of 24 children ventilated for ALI/ARDS in our PICU between January 1993 and December 2002 were reviewed. Five pediatric radiologists and five pediatric intensivists interpreted one frontal chest radiograph (FCR) per patient taken on the day of ALI/ARDS diagnosis. Each reader indicated whether the radiograph showed the AECC radiographic criterion for ALI/ARDS. Data analysis involved comparing each reader to all the others based on the raw agreement and Kappa coefficient (kappa). Features in the 24 patients were consistent with earlier studies. Global inter-observer agreement beyond chance was fair (kappa = 0.29 +/- 0.02) among the five radiologists (kappa = 0.26 +/- 0.05) and among the five intensivists (kappa = 0.29 +/- 0.05). Thus, considerable inter-observer variability occurred in assessing the radiographic criterion for ALI/ARDS, as previously shown in adults. Given the low incidence of ALI/ARDS in children, this variability may have a large impact in studies of pediatric ALI/ARDS.     

Endothelin-1 level in epithelial lining fluid of patients with acute respiratory distress syndrome

BACKGROUND AND OBJECTIVES: Endothelin-1 (ET-1), a potent vasoconstrictor peptide produced by endothelial cells, has been implicated in the dysfunction of various organs. To determine the role of ET-1 in acute lung injury (ALI) and ARDS, ET-1 levels were measured in epithelial lining fluid (ELF) and plasma obtained from patients with ALI/ARDS. METHODS: A cross-sectional study of patients with ALI/ARDS in the intensive care unit of two university hospitals was performed. Patients with ALI/ARDS underwent bronchoscopic microsampling to collect ELF on the day of onset of the disease. Patients who underwent bronchoscopy to examine a small peripheral pulmonary nodule served as controls. RESULTS: In the 23 patients with ALI/ARDS, the ET-1 level in ELF was significantly greater than that in plasma (P < 0.001). In contrast, ET-1 was not detectable in the ELF from six of the seven control subjects. The albumin concentration of ELF, used as a marker of endothelial and epithelial permeability, correlated with the ET-1 level in ELF (P < 0.001). The oxygenation index (PaO(2)/FiO(2)) was also correlated with ET-1 concentration in ELF (P < 0.001). CONCLUSION: In patients with ALI/ARDS, ET-1 is produced mainly in the lung and is associated not only with pulmonary vasoconstriction but also the development of permeability oedema, leading to the impairment of oxygenation.     

不同剂量低分子肝素雾化吸人对急性肺损伤／急性呼吸窘迫综合征的作用

目的探讨不同剂量低分子肝素（LMWH）雾化吸入对急性肺损伤／急性呼吸窘迫综合征ALI／ARDS的治疗作用。方法将急诊ICU收治的（ALI／ARDS）患者64例随机分为对照组、LMWH低剂量雾化治疗组和LMWH高剂量雾化治疗组,分别测定并比较各组治疗前后的氧合指数、急性生理学和长期健康评定（APACHE）Ⅱ评分、7d病死率和凝血功能。结果低剂量和高剂量LMWH雾化吸入治疗后,ALI／ARDS患者的氧合指数提高（P〈0．05）,APACHEⅡ评分及7d病死率降低（P〈0．05）,凝血酶原时间（PT）以及活化部分凝血酶原时间（APTT）无显著变化（P〉0．05）,高、低剂量组间无显著差异,而对照组上述指标均未见明显改变。低、高剂量LMWH雾化吸收治疗组7d病死率均为13．6％,显著低于对照组25％（χ2=0．877,P=0．349）。结论高、低剂量的LMWH雾化吸人治疗均可以改善氧合,缓解ALI／ARDS患者的症状,降低病死率,而且不会引起明显出血倾向,是ALI／ARDS的一种有前景的治疗手段。     

Pediatric acute lung injury: prospective evaluation of risk factors associated with mortality

RATIONALE: The 1994 American European Consensus Committee definitions of acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) have not been applied systematically in the pediatric population. OBJECTIVES: The purpose of this study was to evaluate prospectively the epidemiology and clinical risk factors associated with death and prolonged mechanical ventilation in all pediatric patients admitted to two large, pediatric intensive care units with ALI/ARDS using Consensus criteria. METHODS: All pediatric patients meeting Consensus Committee definitions for ALI were prospectively identified and included in a relational database. MEASUREMENTS AND MAIN RESULTS: There were 328 admissions for ALI/ARDS with a mortality of 22%. Multivariate logistic regression analyses revealed (1) the initial severity of oxygenation defect, as measured by the Pa(O2)/FI(O2) ratio; (2) the presence of nonpulmonary and non-central nervous system (CNS) organ dysfunction; and (3) the presence of CNS dysfunction were independently associated with mortality and prolonged mechanical ventilation. A substantial fraction of patients (28%) did not require mechanical ventilation at the onset of ALI; 46% of these patients eventually required intubation for worsening ALI. CONCLUSIONS: Mortality in pediatric ALI/ARDS is high and several risk factors have major prognostic value. In contrast to ALI/ARDS in adults, the initial severity of arterial hypoxemia in children correlates well with mortality. A significant fraction of patients with pediatric ALI/ARDS can be identified before endotracheal intubation is required. These patients provide a valuable group in whom new therapies can be tested.     

Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India

OBJECTIVE: Outcomes in patients with ARDS/acute lung injury (ALI) may be dependent on the underlying cause. We describe the case mix, clinical behavior, and outcomes of patients with ALI/ARDS resulting from pulmonary causes (ALI/ARDSp) and extrapulmonary causes (ALI/ARDSexp). DESIGN: Retrospective study conducted between January 2001 and June 2005. SETTING: Respiratory ICU (RICU) of a tertiary care hospital in northern India. PATIENTS: All patients fulfilling the criteria for ALI/ARDS and requiring mechanical ventilation for > 24 h. MEASUREMENTS AND RESULTS: Of the 180 patients (ARDS, 140 patients; ALI, 40 patients), 123 patients had ALI/ARDSp, whereas 57 patients had ALI/ARDSexp. The most common cause of ALI/ARDSp was infective pneumonia, whereas the most common cause of ALI/ARDSexp was sepsis. At ICU admission, although patients with ALI/ARDSexp were sicker than those with ALI/ARDSp, there was no difference between the two groups of patients in the development of new organ dysfunction/failure (Delta sequential organ failure assessment [SOFA] scores) or the time to develop the first organ dysfunction/failure (assessed by SOFA scores). The median length of RICU stay was similar in the two groups (5 days [interquartile range (IQR), 6 days] vs 5 days [IQR, 9.5 days], respectively, in patients with ALI/ARDSp and ALI/ARDSexp; p = 0.4). The hospital mortality rate was 47.8% and was not significantly different between the two groups (ALI/ARDSp group, 43.1%; ALI/ARDSexp group, 57.9%; p = 0.06). Multivariate analysis showed the following risk factors for death in the ICU: female gender (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25 to 0.94); SOFA scores (OR, 1.18; 95% CI, 1.07 to 1.3); and DeltaSOFA scores (OR, 1.24; 95% CI, 1.09 to 1.41). There was no significant effect of the category of ARDS on outcome (OR, 1.6; 95% CI, 0.8 to 3.2). CONCLUSIONS: Although patients with ALI/ARDSexp are sicker on ICU admission, the underlying cause of ARDS does not affect the length of ICU stay or hospital survival time.     

Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group.

To determine the incidence and 90-d mortality of acute respiratory failure (ARF), acute lung injury (ALI), and the acute respiratory distress syndrome (ARDS), we carried out an 8-wk prospective cohort study in Sweden, Denmark, and Iceland. All intensive care unit (ICU) admissions (n = 13,346) >/= 15 yr of age were assessed between October 6th and November 30th, 1997 in 132 of 150 ICUs with resources to treat patients with intubation and mechanical ventilation (I + MV) >/= 24 h. ARF was defined as I + MV >/= 24 h. ALI and ARDS were defined using criteria recommended by the American-European Consensus Conference on ARDS. Calculation to correct the incidence for unidentified subjects from nonparticipating ICUs was made. No correction for in- or out-migration from the study area was possible. The population in the three countries >/= 15 yr of age was 11.74 million. One thousand two hundred thirty-one ARF patients were included, 287 ALI and 221 ARDS patients were identified. The incidences were for ARF 77.6, for ALI 17.9, and for ARDS 13.5 patients per 100,000/yr. Ninety-day mortality was 41.0% for ARF, including ALI and ARDS patients, 42.2% for ALI not fulfilling ARDS criteria, and 41.2% for ARDS.     

Aetiologies and outcomes of diffuse alveolar haemorrhage presenting as acute respiratory failure of uncertain cause

Background and objective:   Connective tissue diseases are the most common disorders causing diffuse alveolar haemorrhage (DAH) confirmed by open lung biopsy. However, it is not known whether these diseases are also the most common causes of DAH in patients presenting with the features of ARDS/acute lung injury (ALI). This study evaluated the frequency of concomitant disease in patients with ARDS/ALI and DAH.
Methods:   The sampling frame comprised all patients in a tertiary referral hospital diagnosed with ARDS/ALI and who underwent BAL between January 2000 and July 2006. The medical records of those patients who had BAL fluid findings compatible with DAH were reviewed.
Results:   Of the 97 patients diagnosed with ARDS/ALI and who underwent BAL, 27 had BAL fluid findings compatible with DAH. Sixteen of the 27 patients did not have connective tissue diseases (59%); of these 12 patients had concomitant haematological malignancies or solid tumours. Of the seven patients who presented with DAH and no known underlying disease, only two were subsequently diagnosed with a connective tissue disorder. The in-hospital mortality rate was 55% and 63% for patients with DAH with and without connective tissue diseases, respectively ( P  = 0.710).
Conclusions:   The majority of patients with DAH presenting with the features of ARDS/ALI did not have underlying connective tissue diseases. Concomitant malignancies were found frequently in these patients. The outcome did not differ between patients with DAH with or without connective tissue diseases.