Alcohol Abuse Enhances Pulmonary Edema in Acute Respiratory Distress Syndrome

• Type of Material: Article
• Authors: David Berkowitz, Emory University; Pajman A. Danai, Emory University; Stephanie Eaton, Emory University; Marc Moss, University of Colorado; Gregory Martin, Emory University
• Language: English
• Date: 2009-10-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2009 by the Research Society on Alcoholism.
• Final Published Version (URL): http://dx.doi.org/10.1111/j.1530-0277.2009.01005.x
• Title of Journal or Parent Work: Alcoholism: Clinical and Experimental Research
• ISSN: 0145-6008
• Volume: 33
• Issue: 10
• Start Page: 1690
• End Page: 1696
• Grant/Funding Information: National Institutes of Health; HL 067739 (Martin); P50 AA-013757 (Martin); and R01 AA014435 (Moss).
• Keywords: ARTERIAL THERMODILUTION; Respiratory Distress Syndrome (adult); CHRONIC ETHANOL INGESTION; Life Sciences & Biomedicine; TRANSPULMONARY THERMODILUTION; Substance Abuse; EXTRAVASCULAR LUNG WATER; IDENTIFICATION TEST AUDIT; Science & Technology; CRITICALLY-ILL PATIENTS; Alcoholism; Pulmonary Edema; MULTIPLE ORGAN DYSFUNCTION; EPITHELIAL BARRIER FUNCTION; INTENSIVE-CARE-UNIT; Extravascular Lung Water; GLUTATHIONE HOMEOSTASIS; Sepsis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Pulmonary edema is a cardinal feature of the life-threatening condition known as acute respiratory distress syndrome (ARDS). Patients with chronic alcohol abuse are known to be at increased risk of developing and dying from ARDS. Based upon preclinical data, we hypothesized that a history of chronic alcohol abuse in ARDS patients is associated with greater quantities and slower resolution of pulmonary edema compared with ARDS patients without a history of alcohol abuse. Methods: A PiCCO™ transpulmonary thermodilution catheter was inserted into 35 patients within 72 hours of meeting American European Consensus Criteria definition of ARDS. Pulmonary edema was quantified as extravascular lung water (EVLW) and measured for up to 7 days in 13 patients with a history of chronic alcohol abuse and 22 patients without a history of chronic alcohol abuse. Results: Mean EVLW was higher in patients with a history of chronic alcohol abuse (16.6 vs. 10.5 ml/kg, p < 0.0001). Patients with alcohol abuse had significantly greater EVLW over the duration of the study (RM-ANOVA p = 0.003). There was a trend towards slower resolution of EVLW in patients with a history of alcohol abuse (a decrease of 0.5 ml/kg vs. 2.4 ml/kg, p = 0.17) over the study period. A history of alcohol abuse conferred a greater than 3-fold increased risk of elevated EVLW [OR 3.16, (1.26 to 7.93)] using multivariate logistic regression analysis. Conclusions: In patients who develop ARDS, alcohol abuse is associated with greater levels EVLW and a trend towards slower resolution of EVLW. Combined with mechanistic and preclinical evidence linking chronic alcohol consumption and ARDS, targeted therapies should be developed for these patients.