Gordon D. Rubenfeld, M.D., Ellen Caldwell, M.S., Eve Peabody, B.A., Jim Weaver, R.R.T., Diane P. Martin, Ph.D., Margaret Neff, M.D., Eric J. Stern, M.D., and Leonard D. Hudson, M.D.
Background Acute lung injury is a critical illness syndromeconsisting of acute hypoxemic respiratory failure with bilateralpulmonary infiltrates that are not attributed to left atrialhypertension. Despite recent advances in our understanding ofthe mechanism and treatment of acute lung injury, its incidenceand outcomes in the United States have been unclear.
Methods We conducted a prospective, population-based, cohortstudy in 21 hospitals in and around King County, Washington,from April 1999 through July 2000, using a validated screeningprotocol to identify patients who met the consensus criteriafor acute lung injury.
Results A total of 1113 King County residents undergoing mechanicalventilation met the criteria for acute lung injury and were15 years of age or older. On the basis of this figure, the crudeincidence of acute lung injury was 78.9 per 100,000 person-yearsand the age-adjusted incidence was 86.2 per 100,000 person-years.The in-hospital mortality rate was 38.5 percent. The incidenceof acute lung injury increased with age from 16 per 100,000person-years for those 15 through 19 years of age to 306 per100,000 person-years for those 75 through 84 years of age. Mortalityincreased with age from 24 percent for patients 15 through 19years of age to 60 percent for patients 85 years of age or older(P<0.001). We estimate that each year in the United Statesthere are 190,600 cases of acute lung injury, which are associatedwith 74,500 deaths and 3.6 million hospital days.
Conclusions Acute lung injury has a substantial impact on publichealth, with an incidence in the United States that is considerablyhigher than previous reports have suggested.
Source Information
From the Division of Pulmonary and Critical Care Medicine (G.D.R., E.C., E.P., J.W., M.N., L.D.H.) and the Department of Radiology (E.J.S.), Harborview Medical Center; and the Department of Health Services, School of Public Health and Community Medicine, University of Washington (D.P.M.) — all in Seattle.
Address reprint requests to Dr. Rubenfeld at the Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Box 359762, 325 9th Ave., Seattle, WA 98104-2499, or at nodrog{at}u.washington.edu.
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