Retrospective Investigation Of Patients With Adult Respiratory Distress Syndrome In 10 Years

Objective: To assess prospectively acute respiratory distress syndrome incidence, etiologies, physiologic and clinical features, development of treatment,mortality and its predictors in one intensive care unit.Design: retrospective study.Setting: One general intensive care unit in teaching hospital.Patients: All adult patients admitted between April, 1994 and December, 2003, that met the criteria of the American-European Consensus Conference for acute respiratory distress syndrome.Interventions: None.Methods:A retrospective analysis of 5 314 patients from Apirl 1994 to December 2003 was performed in ICU of Changhai Hospital. A total of 131 patients developed acute respiratory distress syndrome, and 115 survived for >24 hrs. 70.4% were men, and the median age was 58.2 years. Patients were segregated by admission date to the ICU (before or after January 1,2000). Acute Physiology and Chronic Health Evaluation III , Multiple Organ Dysfunction Score, and Lung Injuy Score was determined on the day of onset of ARDS for all patients. Other recorded variables were age, sex, intensive care unit length of stay, length of ventilation, presence or absence of tracheostomy, ventilation variables of mean airway pressures, elective versus emergency surgery. Results: Main risk factors were: pneumonia(34.7%), sepsis (33.0%), and other (32.3%). At admission, nonsurvivors had significantly higher Multiple Organ Dysfuncton Score, and lower BE. During the first week, Multiple Organ Dysfuncton Score and plateau pressure consistently discriminated between survivors and nonsurvivors. Hospital mortality was 55.8%. Main causes of death were multiple organ failure; refractory hypoxemia was uncommon.There was a significant decrease in the ARDS death rate from the period 1994 to 1999 to the period 2000 to 2003. The major reason for the decline might be the management of Continuous Renal Replacement Therapy and the new drugs of mucosulvan and rhGH. Predictors of death at the onset of ARDS were advanced age, Multiple Organ Dysfunction Score ≥8, and Lung Injury Score ≥2.76.Conclusions: Acute respiratory distress syndrome was a frequent syndrome in this cohort. Sepsis and pneumonia were the most common risk factors. Main causes of death were multiple organ failure. Mortality was high but similar to most recent series that included serious comorbidities. In this single-institution series, the death rate from ARDS declined from 1994 to 2003, and the decrease could be related to the use of composite strategies. Based on this patient population, the authors developed a statistical model to evaluate important prognostic indicators (advanced age, Multiple Organ Dysfunction Score, and Lung Injury Score).