Department of Emergency Medicine, Georgetown University Hospital, Washington Hospital Center, Washington, DC, USA.
Acad Emerg Med. 2012 Sep;19(9):E1011-8. doi: 10.1111/j.1553-2712.2012.01429.x.
Acute lung injury (ALI) affects an estimated 190,000 persons per year in U.S. intensive care units (ICUs), but little is known about its prevalence in the emergency department (ED).
The objective was to describe the prevalence of ALI among mechanically ventilated adult nontrauma patients in the ED. The hypothesis was that the prevalence of ALI in adult ED patients would be low.
This was a retrospective cohort study of admitted nontrauma patients presenting to an academic ED. Two trained investigators abstracted data from patient records using a standardized form. The use of mechanical ventilation in the ED was identified in two phases. First, all ED patients were screened for the current procedural terminology (CPT) code for endotracheal intubation (CPT 31500) from January 1, 2003, to December 31, 2006. Second, each patient record was reviewed to verify the use of mechanical ventilation. ALI was defined in accordance with a modified version of the American-European Consensus Conference criteria as: 1) hypoxemia defined as PaO(2) /FiO(2) ratio ≤300 mm Hg on all arterial blood gases (ABGs) in the ED and the first 24 hours of admission, 2) the presence of bilateral infiltrates on chest radiograph, and 3) the absence of left atrial hypertension. Data are presented in absolute numbers and percentages. Interobserver agreement was evaluated using the kappa statistic.
Of the 552 patients who received mechanical ventilation in the ED and were subsequently admitted, a total of 134 (24.3%, 95% confidence interval [CI] = 20.8% to 28.0%) met hypoxemia criteria. Of these, 34 had evidence of left atrial hypertension, 52 did not have chest radiograph findings consistent with ALI, and two did not have a chest radiograph performed; the remaining 46 met ALI criteria. An additional two patients who died in the ED had clinical evidence of ALI. Thus, 48 of 552, or 8.7% (95% CI = 6.6% to 11.3%), met criteria for ALI. The kappa value for determination of ALI was 0.84 (95% CI = 0.54 to 1.0).
The prevalence of ALI was nearly 9% in adult nontrauma patients receiving mechanical ventilation in the ED. Further study is required to determine which types of patients present to the ED with ALI, the extent to which lung protective ventilation is used, and the need for ED ventilator management algorithms.
在美国的重症监护病房（ICU）中，每年约有 19 万名急性肺损伤（ALI）患者，但人们对其在急诊科（ED）中的流行程度知之甚少。
描述接受机械通气的成年非创伤性 ED 患者中 ALI 的患病率。假设是成人 ED 患者中 ALI 的患病率较低。
这是一项对学术 ED 就诊的接受入院治疗的非创伤性患者进行的回顾性队列研究。两名经过培训的研究人员使用标准化表格从患者记录中提取数据。ED 中机械通气的使用分为两个阶段。首先，从 2003 年 1 月 1 日至 2006 年 12 月 31 日，所有 ED 患者均根据当前程序术语（CPT）编码进行气管插管（CPT 31500）筛查。其次，对每个患者的记录进行审查，以验证机械通气的使用情况。ALI 根据美国-欧洲共识会议标准的改良版本定义为：1）ED 和入院后 24 小时内所有动脉血气（ABG）的 PaO 2 /FiO 2 比值均≤300mmHg；2）胸片显示双侧浸润；3）无左心房高压。数据以绝对数字和百分比表示。使用 Kappa 统计评估观察者间一致性。
在 ED 接受机械通气并随后入院的 552 名患者中，共有 134 名（24.3%，95%置信区间[CI]为 20.8%至 28.0%）符合低氧血症标准。其中，34 人有左心房高压的证据，52 人没有胸片显示与 ALI 一致的发现，2 人没有进行胸片检查；其余 46 人符合 ALI 标准。另外两名在 ED 死亡的患者有 ALI 的临床证据。因此，552 名患者中有 48 名（8.7%，95%CI=6.6%至 11.3%）符合 ALI 标准。确定 ALI 的 Kappa 值为 0.84（95%CI=0.54 至 1.0）。
接受 ED 机械通气的成年非创伤性患者中 ALI 的患病率接近 9%。需要进一步研究以确定哪些类型的患者出现 ALI，肺保护性通气的使用程度以及 ED 呼吸机管理算法的需求。
