Risk factors for the development of acute lung injury in patients with septic shock: An observational cohort study

Remzi Iscimen, Rodrigo Cartin-Ceba, Murat Yilmaz, Hasrat Khan, Rolf D. Hubmayr, Bekele Afessa, Ognjen Gajic

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

OBJECTIVE: Almost half of the patients with septic shock develop acute lung injury (ALI). The understanding why some patients do and others do not develop ALI is limited. The objective of this study was to test the hypothesis that delayed treatment of septic shock is associated with the development of ALI. DESIGN: Observational cohort study. SETTING: Medical intensive care unit in a tertiary medical center. PATIENTS: Prospectively identified patients with septic shock who did not have ALI at the outset, excluding those who denied research authorization. MEASUREMENTS AND MAIN RESULTS: High frequency cardio-respiratory monitoring, arterial gas analysis, and portable chest radiographs were reviewed to identify the timing of ALI development. Risk factors present before ALI development were identified by review of electronic medical records and analyzed in univariate and multivariate analyses. Seventy-one of 160 patients (44%) developed ALI at a median of 5 (range 2-94) hours after the onset of septic shock. Multivariate logistic regression analysis identified the following predictors of ALI development: delayed goal-directed resuscitation (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.52-8.63, p = .004), delayed antibiotics (OR 2.39, 95% CI 1.06 -5.59, p = .039), transfusion (OR 2.75, 95% CI 1.22-6.37, p = .016), alcohol abuse (OR 2.09, 95% CI .88-5.10, p = 0.098), recent chemotherapy (OR 6.47, 95% CI 1.99-24.9, p = 0.003), diabetes mellitus (OR .44, 95% CI .17-1.07, p = .076), and baseline respiratory rate (OR 2.03 per sd, 95% CI 1.38-3.08, p < .001). CONCLUSION: When adjusted for known modifiers of ALI expression, delayed treatment of shock and infection were associated with development of ALI.

Original languageEnglish (US)
Pages (from-to)1518-1522
Number of pages5
JournalCritical Care Medicine
Volume36
Issue number5
DOIs
StatePublished - May 2008

Fingerprint

Acute Lung Injury
Septic Shock
Observational Studies
Cohort Studies
Odds Ratio
Confidence Intervals
Electronic Health Records
Respiratory Rate
Resuscitation
Alcoholism
Intensive Care Units
Shock
Diabetes Mellitus
Thorax
Multivariate Analysis
Gases
Logistic Models
Regression Analysis
Anti-Bacterial Agents
Drug Therapy

Keywords

  • Antibiotic
  • Epidemiology
  • Hyperventilation
  • Metabolic acidosis
  • Resuscitation
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Risk factors for the development of acute lung injury in patients with septic shock : An observational cohort study. / Iscimen, Remzi; Cartin-Ceba, Rodrigo; Yilmaz, Murat; Khan, Hasrat; Hubmayr, Rolf D.; Afessa, Bekele; Gajic, Ognjen.

In: Critical Care Medicine, Vol. 36, No. 5, 05.2008, p. 1518-1522.

Research output: Contribution to journalArticle

Iscimen, Remzi ; Cartin-Ceba, Rodrigo ; Yilmaz, Murat ; Khan, Hasrat ; Hubmayr, Rolf D. ; Afessa, Bekele ; Gajic, Ognjen. / Risk factors for the development of acute lung injury in patients with septic shock : An observational cohort study. In: Critical Care Medicine. 2008 ; Vol. 36, No. 5. pp. 1518-1522.
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abstract = "OBJECTIVE: Almost half of the patients with septic shock develop acute lung injury (ALI). The understanding why some patients do and others do not develop ALI is limited. The objective of this study was to test the hypothesis that delayed treatment of septic shock is associated with the development of ALI. DESIGN: Observational cohort study. SETTING: Medical intensive care unit in a tertiary medical center. PATIENTS: Prospectively identified patients with septic shock who did not have ALI at the outset, excluding those who denied research authorization. MEASUREMENTS AND MAIN RESULTS: High frequency cardio-respiratory monitoring, arterial gas analysis, and portable chest radiographs were reviewed to identify the timing of ALI development. Risk factors present before ALI development were identified by review of electronic medical records and analyzed in univariate and multivariate analyses. Seventy-one of 160 patients (44{\%}) developed ALI at a median of 5 (range 2-94) hours after the onset of septic shock. Multivariate logistic regression analysis identified the following predictors of ALI development: delayed goal-directed resuscitation (odds ratio [OR] 3.55, 95{\%} confidence interval [CI] 1.52-8.63, p = .004), delayed antibiotics (OR 2.39, 95{\%} CI 1.06 -5.59, p = .039), transfusion (OR 2.75, 95{\%} CI 1.22-6.37, p = .016), alcohol abuse (OR 2.09, 95{\%} CI .88-5.10, p = 0.098), recent chemotherapy (OR 6.47, 95{\%} CI 1.99-24.9, p = 0.003), diabetes mellitus (OR .44, 95{\%} CI .17-1.07, p = .076), and baseline respiratory rate (OR 2.03 per sd, 95{\%} CI 1.38-3.08, p < .001). CONCLUSION: When adjusted for known modifiers of ALI expression, delayed treatment of shock and infection were associated with development of ALI.",
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T1 - Risk factors for the development of acute lung injury in patients with septic shock

T2 - An observational cohort study

AU - Iscimen, Remzi

AU - Cartin-Ceba, Rodrigo

AU - Yilmaz, Murat

AU - Khan, Hasrat

AU - Hubmayr, Rolf D.

AU - Afessa, Bekele

AU - Gajic, Ognjen

PY - 2008/5

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N2 - OBJECTIVE: Almost half of the patients with septic shock develop acute lung injury (ALI). The understanding why some patients do and others do not develop ALI is limited. The objective of this study was to test the hypothesis that delayed treatment of septic shock is associated with the development of ALI. DESIGN: Observational cohort study. SETTING: Medical intensive care unit in a tertiary medical center. PATIENTS: Prospectively identified patients with septic shock who did not have ALI at the outset, excluding those who denied research authorization. MEASUREMENTS AND MAIN RESULTS: High frequency cardio-respiratory monitoring, arterial gas analysis, and portable chest radiographs were reviewed to identify the timing of ALI development. Risk factors present before ALI development were identified by review of electronic medical records and analyzed in univariate and multivariate analyses. Seventy-one of 160 patients (44%) developed ALI at a median of 5 (range 2-94) hours after the onset of septic shock. Multivariate logistic regression analysis identified the following predictors of ALI development: delayed goal-directed resuscitation (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.52-8.63, p = .004), delayed antibiotics (OR 2.39, 95% CI 1.06 -5.59, p = .039), transfusion (OR 2.75, 95% CI 1.22-6.37, p = .016), alcohol abuse (OR 2.09, 95% CI .88-5.10, p = 0.098), recent chemotherapy (OR 6.47, 95% CI 1.99-24.9, p = 0.003), diabetes mellitus (OR .44, 95% CI .17-1.07, p = .076), and baseline respiratory rate (OR 2.03 per sd, 95% CI 1.38-3.08, p < .001). CONCLUSION: When adjusted for known modifiers of ALI expression, delayed treatment of shock and infection were associated with development of ALI.

AB - OBJECTIVE: Almost half of the patients with septic shock develop acute lung injury (ALI). The understanding why some patients do and others do not develop ALI is limited. The objective of this study was to test the hypothesis that delayed treatment of septic shock is associated with the development of ALI. DESIGN: Observational cohort study. SETTING: Medical intensive care unit in a tertiary medical center. PATIENTS: Prospectively identified patients with septic shock who did not have ALI at the outset, excluding those who denied research authorization. MEASUREMENTS AND MAIN RESULTS: High frequency cardio-respiratory monitoring, arterial gas analysis, and portable chest radiographs were reviewed to identify the timing of ALI development. Risk factors present before ALI development were identified by review of electronic medical records and analyzed in univariate and multivariate analyses. Seventy-one of 160 patients (44%) developed ALI at a median of 5 (range 2-94) hours after the onset of septic shock. Multivariate logistic regression analysis identified the following predictors of ALI development: delayed goal-directed resuscitation (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.52-8.63, p = .004), delayed antibiotics (OR 2.39, 95% CI 1.06 -5.59, p = .039), transfusion (OR 2.75, 95% CI 1.22-6.37, p = .016), alcohol abuse (OR 2.09, 95% CI .88-5.10, p = 0.098), recent chemotherapy (OR 6.47, 95% CI 1.99-24.9, p = 0.003), diabetes mellitus (OR .44, 95% CI .17-1.07, p = .076), and baseline respiratory rate (OR 2.03 per sd, 95% CI 1.38-3.08, p < .001). CONCLUSION: When adjusted for known modifiers of ALI expression, delayed treatment of shock and infection were associated with development of ALI.

KW - Antibiotic

KW - Epidemiology

KW - Hyperventilation

KW - Metabolic acidosis

KW - Resuscitation

KW - Shock

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