SUMMARIES FOR PATIENTS
How Well Do Clinical and Lung Tissue Criteria for the Acute Respiratory Distress Syndrome Match?
21 September 2004 | Volume 141 Issue 6 | Page I-42
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The summary below is from the full report titled "Comparison of Clinical Criteria for the Acute Respiratory Distress Syndrome with Autopsy Findings." It is in the 21 September 2004 issue of Annals of Internal Medicine (volume 141, pages 440-445). The authors are A. Esteban, P. Fernández- Segoviano, F. Frutos-Vivar, J.A. Aramburu, L. Nájera, N.D. Ferguson, I. Alía, F. Gordo, and F. Ríos.
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What is the problem and what is known about it so far?
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The acute respiratory distress syndrome (ARDS) is a sudden, serious, and sometimes fatal condition. In ARDS, the lungs become inflamed and filled with fluid so that they do not absorb oxygen well. Many diseases and injuries can lead to ARDS, including pneumonia, breathing in vomited stomach contents, near-drowning, severe burns, and bloodstream infections. Clinical doctors usually use several criteria to diagnose ARDS, including chest x-ray findings and low levels of oxygen in the blood. Pathologists (doctors who diagnose diseases by examining tissue under a microscope) also use a specific pattern of tissue injury (diffuse alveolar damage) to diagnose ARDS. Few studies examine whether all patients who meet clinical criteria for ARDS actually have lung tissue findings that confirm that diagnosis.
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Why did the researchers do this particular study?
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To see whether clinical and lung tissue criteria for ARDS match closely.
382 patients who had autopsies after dying in an intensive care unit of a Spanish hospital between 1991 and 2002.
The researchers reviewed medical charts to see which patients met established clinical criteria for ARDS and to assess causes of that condition. They also looked at lung tissue reports for specific evidence of ARDS (diffuse alveolar damage). They then checked whether findings matched better in certain groups of patients.
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What did the researchers find?
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One hundred twenty-seven patients met clinical criteria for ARDS and 112 patients met lung tissue criteria. Of the 127 patients who met clinical criteria, only two thirds had lung tissue findings for ARDS. Also, only three quarters of the 112 patients with lung tissue findings met clinical criteria. Clinical and lung tissue criteria matched best in patients whose illnesses resulted from a disease that started outside the chest.
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What are the limitations of the study?
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The study included patients from 1 hospital who had died and had an autopsy. Patients with less severe disease may have different findings.
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What are the implications of the study?
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In severely ill patients, clinical criteria and lung tissue findings for ARDS are not closely linked. Whether the clinical or the lung tissue definition of ARDS should be changed is not clear.
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