quarta-feira, fevereiro 13, 2008

Mortality rates for patients with ALI/ARDS have decreased over time

Revisão recente publicada no Chest demonstra redução significativa de mortalidade em pacientes com ALI/ARDS.
Nessa revisão sistemática realizada por Zambon & Vincent fica evidente que a mrtalidade descrita nos diversos estudos é extremamente vari;avel, fato que possivielmente deve-se a problemas ligados a definição de ALI/ARDS, ao local de realiza,cão do estudo e ainda ao cenário (clinical trial vs estudo epidemiológico).
Estudos epidemiologicos frequentemente são retratos mais fiéis do "mundo real"ao passo que clinical trials tendem a super-selecionar os pacientes incluidos. De toda forma é interessante obsercar que ainda qeu não haja avanços farmacológicos na área, a melhoria das medidas de suporte e possivelmente a redução de modos de ventilação iatrogenicos tiveram impacto na mortalidade de pacientes com ALI/ARDS.


First published online on February 8, 2008
Chest, doi:10.1378/chest.07-2134


Mortality rates for patients with ALI/ARDS have decreased over time

Massimo Zambon, MD and Jean-Louis Vincent, MD, PhD, FCCP
Dept of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Belgium


Background Over the last decade, several studies have suggested that survival rates for patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) may have improved. We performed a systematic analysis of the ALI/ARDS literature to document possible trends in mortality between 1994 and 2006.

Methods We used the Medline database to select studies with the keywords "acute lung injury", "acute respiratory distress syndrome", "acute respiratory failure", "mechanical ventilation". All studies that reported mortality for patients with ALI/ARDS defined according to the criteria of the American European Consensus Conference were selected. We excluded studies with less than 30 patients and studies limited to specific subgroups of ARDS patients, such as sepsis, trauma, burns or transfusion-related ARDS.

Results Seventy-two studies were included in the analysis. There was a wide variation in mortality rates among the studies, from 15-72%. The overall pooled mortality rate for all studies was 43% (95% CI 40-46%). Meta-regression analysis suggested a significant decrease in overall mortality rates of approximately 1.1% per year over the period analyzed (1994-2006). The mortality reduction was also observed for hospital but not for ICU or 28-day mortality.

Conclusions In this literature review, the data are consistent with a reduction in mortality rates in general populations of patients with ALI/ARDS over the last 10 years.