Acute Respiratory Distress Syndrome (ARDS) in Ramathibodi Hospital: Risks and Prognostic Factors
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Date
2010-04-08
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Thai Journal of Tuberculosis Chest Diseases and Critical Care
Abstract
Objectives: To study the outcome of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in medical ICU, Ramathibodi Hospital and identify factors that contribute independently to mortality. Study design: Retrospective study. Methods: All patients admitted in medical ICU between January 1998 and December 2002, that met the criteria of the American-European Consensus Conference for ALI and ARDS were reviewed. The data collection included patient baseline characteristics, risk factors for ARDS, initial PaO₂/FiO₂, PaO₂/PAO₂, static lung compliance, best PEEP level, APACHE II score, associated early and late nonpulmonary organ dysfunction, mode of ventilator, ventilator days, outcomes and complications. The probability of death and median survival time were assessed by Kaplan-Meier method. Prognostic factors associated with mortality were determined by Cox Proportional Hazard method. Results: A total of 48 patients met the criteria of ALI and ARDS. The mean age of these patients was 46.8 \±18 yrs. Direct lung injuries were the most common causes of ARDS in this series (35/48), of which pneumonia attributed to the majority of cases (80%). The mean APACHE II score of the group was 20.9\±7.4, with 70.8% hospital mortality. Main cause of death was multiple organ dysfunction, while refractory hypoxemia was less common. Factors independently associated with mortality were initial APACHE II score of more than 20 (hazard ratio, 2.09; 95%CI 1.02 to 4.32) and the presence of circulatory dysfunction 24 h after the onset of ARDS (hazard ratio, 5.78; 95%CI 2.11 to 15.86). Conclusion: Mortality rate of ARDS in medical patients had been unchanged. The extreme high mortality (70.8%) in this group could be due to the high proportion of patients with pneumonia and sepsis. Only initial APACHE II score of more than 20 and the presence of circulatory dysfunction were found to be the independent predictors of mortality. These further confirmed and emphasized the concept of \“lung as a part of systemic inflammatory process\” in ARDS.
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Thai Journal of Tuberculosis Chest Diseases and Critical Care; Vol.29 No.3 July-September 2008; 231-240