Alcohol is the most commonly abused drug in the world. In the intensive care unit (ICU), patients with a history of alcohol abuse are common, and their rate of mortality and ICU-related morbidity are significantly higher when compared to non-alcoholics. Though ICU patients are a heterogeneous group, Acute Respiratory Distress Syndrome (ARDS) is one of the more frequent diagnoses among these critically ill patients, and its course is characterized by several stages, including an acute and recovery phase. Our group has pioneered the clinical research concerning the association between alcohol abuse and ARDS. We have determined that chronic alcohol abuse significantly increases the risk of developing ARDS. This association is a common phenomenon as 50% of all ARDS patients had a prior history of alcohol abuse in our patient population. Based upon the extensive evidence implicating the depletion of glutathione in the pathogenesis of alcohol mediated liver disease, we have focused on the possibility that alterations in pulmonary and systemic glutathione homeostasis may increase susceptibility to ARDS. We have reported that chronic alcohol abuse in humans was associated with decreased glutathione concentrations in the epithelial lining fluid of the lung. In the first part of this project, we will determine the diagnostic ability of alcohol-related alterations in glutathione homeostasis on the initial development of ARDS (acute effects). In the second part of this project, we will also examine the effects of alcohol abuse that only become apparent during the recovery phase of ARDS. As the number of ARDS survivors continues to increase, it is evident that our understanding of their physical impairment and dysfunction in health related quality of life is limited. Though ARDS survivors begin to improve after 3 months, patients who remain impaired have more difficulty with general medical health issues and neuromuscular problems than specific pulmonary dysfunction. Presently, the impact of prior medical conditions, such as chronic alcohol abuse, on ARDS survivors is unknown. Therefore we will determine the effects of chronic alcohol abuse on the development of neuromuscular dysfunction and subsequent long term health-related quality of life (late effects) in ARDS survivors.
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