Diagnosing acute lung injury in the critically ill: a national survey among critical care physicians.

ABSTRACT

BACKGROUND: Incidence reports on acute lung injury (ALI) vary widely. An insight into the diagnostic preferences of critical care physicians when diagnosing ALI may improve identification of the ALI patient population. METHODS: Critical care physicians in the Netherlands were surveyed using vignettes involving hypothetical patients and a questionnaire. The vignettes varied in seven diagnostic determinants based on the North American European Consensus Conference and the lung injury score. Preferences were analyzed using a mixed-effects logistic regression model and presented as an odds ratio (OR) with a 95% confidence interval. RESULTS: From 243 surveys sent to 30 hospitals, 101 were returned (42%). ORs were as follows chest X-ray consistent with ALI OR 1.7 (1.3-2.3), high positive end-expiratory pressure (PEEP) (15 cmH(2)O) OR 5.0 (3.9-6.6), low pulmonary artery occlusion pressures (PAOP) (<18 mmHg) OR 4.7 (3.6-6.1), low compliance (30 ml/cmH(2)O) OR 0.7 (0.5-0.9), low PaO(2)/FiO(2) (<250 mmHg) OR 9.2 (6.9-12.3), absence of heart failure OR 1.2 (0.9-1.5), presence of a risk factor for ALI (sepsis) OR 1.0 (0.8-1.3). The questionnaire revealed that critical care physicians with an anesthesiology background differed from physicians with an internal medicine background with regard to hemodynamic variables when considering an ALI diagnosis (P<0.05). CONCLUSIONS: Dutch critical care physicians consider the PEEP level, but not the presence of a risk factor for ALI, as an important factor to diagnose ALI. Background specialty of critical care physicians influences diagnostic preferences and may account for variance in the reported incidence of ALI.