Log in | Register

Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition

Aude Gibelin| Antoine Parrot| Bernard Maitre| Christian Brun-Buisson| Armand Mekontso Dessap| Muriel Fartoukh| Nicolas de Prost
Original
Volume 42, Issue 2 / February , 2016

Pages 164 - 172

Abstract

Purpose

Some patients presenting with acute respiratory failure and meeting the Berlin criteria for acute respiratory distress syndrome (ARDS) lack exposure to common risk factors (CRF). These so-called ARDS mimickers often lack histological diffuse alveolar damage. We aimed to describe such ARDS mimickers lacking CRF (ARDSCRF−) in comparison with others (ARDSCRF+).

Methods

Retrospective study including all patients receiving invasive mechanical ventilation for ARDS admitted to the intensive care units (ICUs) of two tertiary care centers from January 2003 to December 2012.

Results

The prevalence of ARDSCRF− was 7.5 % (95 % CI [5.5–9.5]; n = 50/665). On the basis of medical history, bronchoalveolar lavage fluid cytology, and chest CT scan patterns, four etiological categories were identified: immune (n = 18; 36 %), drug-induced (n = 13; 26 %), malignant (n = 7; 14 %), and idiopathic (n = 12; 24 %). Although the ARDSCRF− patients had a lower logistic organ dysfunction score (4 [3–8] vs. 10 [6–13]; p < 0.0001) and less often shock upon ICU admission (44 vs. 80 %; p < 0.0001) than their counterparts, their overall ICU mortality rate was very high (66 % [46–74]), and the absence of CRF remained associated with ICU mortality by multivariable logistic regression analysis (adjusted OR = 2.06; 95 % CI [1.02–4.18]; p = 0.044). Among ARDSCRF− patients, the presence of potentially reversible lung lesions with corticosteroids (aOR = 0.14; 95 % CI [0.03–0.62]) was associated with ICU survival.

Conclusions

The absence of CRF among patients with ARDS is common and associated with a higher risk of mortality. For such atypical ARDS, a complete diagnostic workup, including bronchoalveolar lavage fluid cytology and chest CT scan patterns, should be performed to identify those patients who might benefit from specific therapies, including corticosteroids.

Keywords

References

  1. Ranieri VM, Rubenfeld GD, Thompson BT et al (2012) Acute respiratory distress syndrome: the Berlin definition. JAMA 307:2526–2533. doi:10.1001/jama.2012.5669
    • View reference on PubMed
  2. Bernard GR, Artigas A, Brigham KL et al (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824. doi:10.1164/ajrccm.149.3.7509706
  3. Ferguson ND, Frutos-Vivar F, Esteban A et al (2005) Acute respiratory distress syndrome: underrecognition by clinicians and diagnostic accuracy of three clinical definitions. Crit Care Med 33:2228–2234
    • View reference on publisher's website
    • View reference on PubMed
  4. Esteban A, Fernández-Segoviano P, Frutos-Vivar F et al (2004) Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Ann Intern Med 141:440–445
    • View reference on publisher's website
    • View reference on PubMed
  5. Schwarz MI, Albert RK (2004) “Imitators” of the ARDS: implications for diagnosis and treatment. Chest 125:1530–1535
    • View reference on publisher's website
    • View reference on PubMed
  6. Guérin C, Thompson T, Brower R (2014) The ten diseases that look like ARDS. Intensive Care Med. doi:10.1007/s00134-014-3608-x
  7. Jennette JC, Falk RJ, Andrassy K et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37:187–192
    • View reference on publisher's website
    • View reference on PubMed
  8. Dhokarh R, Li G, Schmickl CN et al (2012) Drug-associated acute lung injury: a population-based cohort study. Chest 142:845–850. doi:10.1378/chest.11-2103
    • View reference on publisher's website
    • View reference on PubMed
  9. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
    • View reference on publisher's website
    • View reference on PubMed
  10. Le Gall JR, Klar J, Lemeshow S et al (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA J Am Med Assoc 276:802–810
    • View reference on publisher's website
    • View reference on PubMed
  11. Hansell DM, Bankier AA, MacMahon H et al (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246:697–722. doi:10.1148/radiol.2462070712
    • View reference on publisher's website
    • View reference on PubMed
  12. Gay SE, Kazerooni EA, Toews GB et al (1998) Idiopathic pulmonary fibrosis: predicting response to therapy and survival. Am J Respir Crit Care Med 157:1063–1072. doi:10.1164/ajrccm.157.4.9703022
    • View reference on publisher's website
    • View reference on PubMed
  13. Wells AU, Hansell DM, Rubens MB et al (1993) The predictive value of appearances on thin-section computed tomography in fibrosing alveolitis. Am Rev Respir Dis 148:1076–1082. doi:10.1164/ajrccm/148.4_Pt_1.1076
    • View reference on publisher's website
    • View reference on PubMed
  14. Terriff BA, Kwan SY, Chan-Yeung MM, Müller NL (1992) Fibrosing alveolitis: chest radiography and CT as predictors of clinical and functional impairment at follow-up in 26 patients. Radiology 184:445–449. doi:10.1148/radiology.184.2.1620845
    • View reference on publisher's website
    • View reference on PubMed
  15. Thille AW, Esteban A, Fernández-Segoviano P et al (2013) Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy. Am J Respir Crit Care Med 187:761–767. doi:10.1164/rccm.201211-1981OC
    • View reference on publisher's website
    • View reference on PubMed
  16. Patel SR, Karmpaliotis D, Ayas NT et al (2004) The role of open-lung biopsy in ARDS. Chest 125:197–202
    • View reference on publisher's website
    • View reference on PubMed
  17. Papazian L, Doddoli C, Chetaille B et al (2007) A contributive result of open-lung biopsy improves survival in acute respiratory distress syndrome patients. Crit Care Med 35:755–762. doi:10.1097/01.CCM.0000257325.88144.30
    • View reference on publisher's website
    • View reference on PubMed
  18. Guerin C, Bayle F, Leray V et al (2015) Open lung biopsy in nonresolving ARDS frequently identifies diffuse alveolar damage regardless of the severity stage and may have implications for patient management. Intensive Care Med 41:222–230. doi:10.1007/s00134-014-3583-2
  19. Katzenstein AL, Myers JL, Mazur MT (1986) Acute interstitial pneumonia. A clinicopathologic, ultrastructural, and cell kinetic study. Am J Surg Pathol 10:256–267
    • View reference on publisher's website
    • View reference on PubMed
  20. Olson J, Colby TV, Elliott CG (1990) Hamman-Rich syndrome revisited. Mayo Clin Proc 65:1538–1548
    • View reference on publisher's website
    • View reference on PubMed
  21. Azoulay E, Lemiale V, Mokart D et al (2014) Acute respiratory distress syndrome in patients with malignancies. Intensive Care Med 40:1106–1114. doi:10.1007/s00134-014-3354-0
  22. Carrillo A, Gonzalez-Diaz G, Ferrer M et al (2012) Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure. Intensive Care Med 38:458–466. doi:10.1007/s00134-012-2475-6
  23. Guérin C, Reignier J, Richard J-C et al, PROSEVA Study Group (2013) Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 368:2159–2168. doi:10.1056/NEJMoa1214103
    • View reference on publisher's website
  24. Wells AU, Desai SR, Rubens MB et al (2003) Idiopathic pulmonary fibrosis: a composite physiologic index derived from disease extent observed by computed tomography. Am J Respir Crit Care Med 167:962–969. doi:10.1164/rccm.2111053
    • View reference on publisher's website
    • View reference on PubMed
  25. Idell S, Cohen AB (1985) Bronchoalveolar lavage in patients with the adult respiratory distress syndrome. Clin Chest Med 6:459–471
    • View reference on PubMed
  26. Caironi P, Carlesso E, Gattinoni L (2006) Radiological imaging in acute lung injury and acute respiratory distress syndrome. Semin Respir Crit Care Med 27:404–415. doi:10.1055/s-2006-948294
    • View reference on publisher's website
    • View reference on PubMed
  27. Zafrani L, Lemiale V, Lapidus N et al (2014) Acute respiratory failure in critically ill patients with interstitial lung disease. PLoS One 9:e104897. doi:10.1371/journal.pone.0104897
    • View reference on publisher's website
    • View reference on PubMed
  28. Amato MBP, Meade MO, Slutsky AS et al (2015) Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 372:747–755. doi:10.1056/NEJMsa1410639
    • View reference on publisher's website
    • View reference on PubMed
  29. (2000) 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 342:1301–1308. doi: 10.1056/NEJM200005043421801
  30. Papazian L, Thomas P, Bregeon F et al (1998) Open-lung biopsy in patients with acute respiratory distress syndrome. Anesthesiology 88:935–944
    • View reference on publisher's website
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement