Intensive Care Med

Purpose:Exposures to ambient air pollutants may prime the lung enhancing risk of acute respiratory distress syndrome (ARDS) in sepsis. Our objective was to determine the association of short-, medium-, and long-term pollutant exposures and ARDS risk in critically ill sepsis patients.Methods:We analyzed a prospective cohort of 1,858 critically ill patients with sepsis, and estimated short- (3-day), medium- (6-weeks), and long- (5-years) term exposures to ozone, nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), particulate matter <2.5 \u3bcm (PM2.5), and PM<10 \u3bcm (PM10) using weighted averages of daily levels from monitors within 50 km of subjects\u2019 residences. Subjects were followed for 6 days for ARDS by the Berlin Criteria. The association between each pollutant and ARDS was determined using multivariable logistic regression adjusting for preselected confounders. In 764 subjects, we measured plasma concentrations of inflammatory proteins at presentation and tested for an association between pollutant exposure and protein concentration via linear regression.Results:ARDS developed in 754 (41%) subjects. Short- and long-term exposures to SO2, NO2, and PM2.5 were associated with ARDS risk (SO2: OR for the comparison of the 75th to 25th long term exposure percentile 1.43(95% CI 1.16, 1.77);p