Trial Information

Etiologies and Outcomes Analysis of Acute Respiratory Failure in Community

Acute respiratory failure (ARF) remains a common reason for admission to the intensive care
unit (ICU). ARF to be present in 32% of patients on ICU admission, with a further 24% of
patients developing ARF during the ICU stay [1]. A total of 56% of all ICU admissions for a
length of >48 h had ARF at some point during their stay [1]. The incidence of ARF was from
88.6 to 137.1 hospitalizations per 100,000 residents [2, 3]. The incidence of ARF was found
to increase nearly exponentially with each decade until age 85 years. However, there is
still paucity data about etiology and outcomes of acute respiratory failure happened in
community.

Mortality of ARF in critically ill patients is between 40% and 65% [2, 4-6]. Independent
hazards for ARF mortality include older age, severe chronic co-morbidities (HIV, active
malignancy, cirrhosis), certain precipitating events (trauma, drug overdose, bone marrow
transplant), and multiple organ system failure (MOSF) [7-9]. Mortality has also been
associated with acute lung injury or bilateral infiltrates on chest radiograph [6], and with
an elevated acute physiology score [9-10].

ARF patients form a large percentage of all ICU admissions and many factors might influence
the final outcomes. With the high incidence of ARF in ICU, any improvement in the outcome of
such population is likely to have marked effect on intensive care resource allocation. We
wish this study may provide some valuable information about acute respiratory failure in
community and improve the outcome of these patients.

References:

1. Vincent JL, Akca S, De Mendonca A, et al: The epidemiology of acute respiratory failure
in critically ill patients. Chest 2002; 121:1602-1609

2. Lewandowski K, Mets J, Deutschmann H, et al. Incidence, severity, and mortality of
acute respiratory failure in Berlin, Germany. Am J Respir Crit Care Med 1995;
151:1121-1125

3. Behrendt CE. Acute respiratory failure in the United States: incidence and 31-day
survival. Chest 2000; 118:1100-1105

4. Miberg JA, Davis DR, Steinberg KP, et al. Improved survival of patients with acute
respiratory distress syndrome (ARDS): 1983-1993. JAMA 1995; 273:306-309

5. Doyle LA, Szaflarski N, Modin GW, et al. Identification of patients with acute lung
injury: predictors of mortality. Am J Respir Crit Care Med 1995; 152:1818-1824

6. Luhr OR, Antonsen K, Karlsson M, et al. Incidence and mortality after acute respiratory
failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland: The
ARF Study Group. Am J Respir Crit Care Med 1999; 159:1849-1861

7. Vasilyev S, Schaap RN, Mortensen JD. Hospital survival rates of patients with acute
respiratory failure in modern respiratory intensive care units. Chest 1995;
107:1083-1088

8. Stauffer JL, Fayter NA, Graves B, et al. Survival following mechanical ventilation for
acute respiratory failure in adult men. Chest 1993; 104:1222-1229

9. Knaus WA. Prognosis with mechanical ventilation: the influence of disease, severity of
disease, age, and chronic health status on survival from an acute illness. Am Rev
Respir Dis 1989; 140:S8-S13

10. Epstein SK, Vuong V. Lack of influence of gender on outcomes of mechanically ventilated
medical ICU patients. Chest 1999; 116:732-739