Clinical outcomes of acute respiratory distress syndrome in a university hospital

	Overall	Mild ARDS	Moderate ARDS	Severe ARDS
N (%)	266 (100.0%)	31 (11.7%)	118 (44.4%)	117 (44.0%)
Age (years), mean ± SD	54.81 ± 18.66	48.84 ± 21.40	53.67 ± 18.64	57.54 ± 17.56
Gender, n (%)
Male	153 (57.5%)	16 (51.6%)	66 (55.9%)	71 (60.7%)
Female	113 (42.5%)	15 (48.4%)	52 (44.1%)	46 (39.3%)
BMI (kg/m²), mean ± SD	22.21 ± 4.44	21.91 ± 3.59	21.96 ± 3.97	22.56 ± 5.11
Etiology of ARDS (%)
Pneumonia	217 (81.6%)	26 (83.9%)	100 (84.7%)	91 (77.8%)
Sepsis	25 (9.4%)	4 (12.9%)	6 (5.1%)	15 (12.8%)
HLH	3 (1.1%)	0 (0%)	2 (1.7%)	1 (0.9%)
Pneumonitis	10 (3.8%)	1 (3.2%)	4 (3.4%)	5 (4.3%)
Multiple factors	6 (2.3%)	0 (0%)	5 (4.2%)	1 (0.9%)
Unspecified cause	2 (0.8%)	0 (0%)	1 (0.8%)	1 (0.9%)
Diffuse alveolar hemorrhage	3 (1.1%)	0 (0%)	0 (0%)	3 (1.1%)
APACHE II median (25%, 75% quartile)	26 (22, 31)	23.16 (19, 27)	25.09 (21, 29)	27.69 (23, 32)
PaO₂/FiO₂, day 1, mean ± SD	122.40 ± 58.64	237.88 ± 53.81	138.96 ± 28.08	75.29 ± 18.04
Initial mode (%)
PCV	233 (87.6%)	22 (71%)	105 (89%)	106 (90.6%)
VCV	5 (1.9%)	1 (3.2%)	2 (1.7%)	2 (1.7%)
PSV	14 (5.3%)	4 (12.9%)	5 (4.2%)	5 (4.3%)
SIMV	2 (0.8%)	1 (3.2%)	1 (0.8%)	0 (0%)
NIV	7 (2.6%)	2 (6.5%)	1 (0.8%)	4 (3.4%)
Bird mark 7	4 (1.5%)	0 (0%)	4 (3.4%)	0 (0%)
Nasal high flow	1 (0.4%)	1 (3.2%)	0 (0%)	0 (0%)
Adjunctive interventions (%)
APRV	15 (5.6%)	1 (3.2%)	4 (3.4%)	10 (8.5%)
HFOV	4 (1.5%)	0 (0%)	3 (2.5%)	1 (0.9%)
Prone	10 (3.8%)	0 (0%)	5 (4.2%)	5 (4.3%)
Recruitment maneuver	128 (48.1%)	10 (32.3%)	58 (49.1%)	60 (51.3%)
PIP in PCV, day 1,	31 ± 6	27 ± 5	31 ± 6	32 ± 6
mean ± SD (cm H₂O)
TV/kg IBW day 1,	8.56 ± 2.48	8.71 ± 2.22	8.45 ± 2.56	8.64 ± 2.47
mean ± SD (mL/kg IBW)
PEEP, day 1,	10 ± 4	7 ± 3	10 ± 4	12 ± 5
mean ± SD (cm HO) ₂
Neuromuscular blockade use (%)	94 (35.3%)	7 (22.6%)	46 (39%)	41 (35%)
Sedative drugs (%)	229 (86.1%)	25 (80.6%)	102 (86.4%)	102 (87.2%)
Morphine	30 (11.3%)	1 (3.2%)	11 (9.3%)	18 (15.4%)
Fentanyl	194 (72.9%)	22 (71.0%)	86 (72.9%)	86 (73.5%)
Midazolam	197 (74.0%)	20 (64.5%)	87 (73.7%)	90 (76.9%)
Propofol	45 (16.9%)	7 (22.3%)	19 (16.1%)	19 (16.2%)
I/O balance, day 1,	2,484.94 ± 2,406.92	2,221.45 ± 2,202.28	2,161.26 ± 2,145.60	2,881.19 ± 2,694.55
mean ± SD (mL/day)
Total I/O balance in 3 days,	5,029.31 ± 4,550	3,760 ± 3,370	4,370 ± 4,306	6,037 ± 4,892
mean ± SD (mL/day)
Total I/O balance in 7 days,	6,634.97 ± 6,718.06	4,615.92 ± 6,327.18	5,771.69 ± 6,947.38	8,052.71 ± 6,337.84
mean ± SD (mL/day)
Enteral calories (kcal/day), AVG in	673.75 ± 546.29	651.57 ± 590.71	724.63 ± 533.06	628.30 ± 547.78
7 days, mean ± SD
Ventilator day (days), mean ± SD	16.46 ± 20.11	24.77 ± 30.88	16.61 ± 17.38	14.11 ± 20.11
Hospital LOS (days), mean ± SD	27.1 ± 26.47	34.26 ± 33.60	29.63 ± 25.01	22.65 ± 25.26
7-day mortality, n (%)	83 (31.1)	4 (12.9)	30 (25.4)	49 (41.9)
28-day mortality, n (%)	184 (69.2)	16 (51.6)	82 (69.5)	86 (73.5)

Comparison of 28-day mortality of ARDS patients and factors possibly associated with mortality between our study and other studies including ALIEN, LUNG SAFE, PRoVENT, and APRONET

	Our study	ALIEN	LUNG SAFE	PRoVENT	APRONET
		[18]	[15]	[19]	[20]
Study period	2010–2014	2008–2009	2014	2014–2015	2016–2017
28-day mortality
All severity of ARDS	69.2%	42.7%	34.8%	29%	NA
Mild ARDS	51.6%	NA	29.6%	NA	NA
Moderate ARDS	69.5%	NA	35.2%	NA	NA
Severe ARDS	73.5%	NA	40.9%	NA	NA
Factors
TV (mL/kg IBW) on day 1	8.56 ± 2.48	7.2 ± 1.1	7.6	7.6	6.7
Percentage of patients with TV >8 mL/kg IBW on day 1	42.3%	NA	NA	30%	NA
Percentage of Pplat measurement	4%	17.2%	40%	41%	90.7%
Percentage of patients with prone position (in severe ARDS)	4%	NA	16%	NA	32.9%
Percentage of patients receiving neuromuscular blockage	35.3%	NA	21.7%	NA	NA
Percentage of patients with recruitment maneuver	48.1%	NA	20.9%	NA	NA
Percentage of patients with ECMO	0%	NA	3.2%	NA	1.9%
Percentage of patients with HFOV	1.5%	NA	1.2%	NA	NA
Percentage of patients with APRV	5.63%	NA	NA	NA	NA

Univariate analysis for 7- and 28-day mortalities

Univariate analysis	7-day mortality			28-day mortality
	Crude HR	95% CI	P	Crude HR	95% CI	P
Age (years)	1.015	1.001–1.030	0.04	1.023	1.009–1.038	<0.01*
Gender
Male (%)	1			1
Female (%)	0.742	0.436–1.262	0.27	0.789	0.468–1.333	0.38
BMI	0.994	0.930–1.063	0.87	0.967	0.906–1.031	0.31
ARDS severity
Mild	1			1
Moderate	2.301	0.744–7.115	0.15	2.135	0.954–4.781	0.07
Severe	4.684	1.599–14.795	<0.01*	2.601	1.151–5.878	0.02*
APACHE II	1.108	1.060–1.159	<0.01*	1.101	1.055–1.150	<0.01*
PaO₂/FiO₂ ratio, day 1	0.992	0.987–0.997	<0.01*	0.997	0.993–1.001	0.18
Mean PaO₂/FiO₂ ratio	0.99	0.980–0.992	<0.01*	0.994	0.990–0.998	<0.01*
TV/kg IBW, day 1	0.996	0.883–1.124	0.95	0.914	0.810–1.031	0.14
Mean TV/kg IBW	0.924	0.801–1.067	0.28	0.917	0.802–1.048	0.20
PEEP, day 1	1.006	0.948–1.067	0.85	0.966	0.911–1.024	0.25
Mean PEEP	1.030	0.965–1.100	0.37	0.994	0.931–1.062	0.86
PIP, day 1	1.061	1.004–1.121	0.04	1.040	0.983–1.101	0.17
Recruitment maneuver	0.910	0.542–1.529	0.77	1.312	0.778–2.211	0.31
Pneumothorax	0.478	0.226–1.008	0.05	1.079	0.553–2.104	0.82
Neuromuscular blockade	0.718	0.412–1.252	0.22	1.471	0.840–2.578	0.18
I/O balance, day 1 (L/day)	1.325	1.175–1.495	<0.01*	1.200	1.063–1.354	<0.01*
Total I/O balance in 3 days (L/day)	1.229	1.142–1.324	<0.01*	1.137	1.066–1.212	<0.01*
Total I/O balance in 7 days (L/day)	1.112	1.071–1.176	<0.01*	1.128	1.077–1.181	<0.01*
7-day AVG enteral calories (kcal/day)	0.998	0.997–0.999	<0.01*	0.999	0.998–0.999	<0.01*

Multivariate analysis for 7- and 28-day mortalities

Multivariate analysis	7-day mortality^†			28-day mortality^‡
	Adjusted HR	95% CI	P	Adjusted HR	95% CI	P
Age (years)	1.004	0.985–1.023	0.70	1.002	0.979–1.027	0.63
ARDS severity
Mild	1			1
Moderate	1.608	0.308–8.388	0.57	7.65	0.878–66.662	0.66
Severe	1.835	0.204–16.539	0.59	14.00	0.715–274.194	0.82
APACHE II	1.050	0.995–1.108	0.94	1.151	1.073–1.235	<0.01*
PaO₂/FiO₂ ratio, day 1	1.003	0.995–1.011	0.50	1.003	0.994–1.013	0.46
Mean PaO₂/FiO₂ ratio	0.988	0.981–0.994	<0.01*	0.997	0.989–1.006	0.55
TV/kg IBW, day 1				1.001	0.997–1.004	0.68
PIP, day 1				1.037	0.966–1.114	0.32
Neuromuscular blockade				1.218	0.524–2.832	0.65
I/O balance, day 1	0.984	0.818–1.182	0.86	0.816	0.666–0.998	0.048*
(L/day)
Total I/O balance in 3 days (L/day)	1.192	1.102–1.289	<0.01*	0.969	0.802–1.169	0.74
Total I/O balance in 7 days (L/day)	1.061	0.979–1.150	0.15	1.103	1.026–1.186	<0.01*
7-day AVG enteral calories (kcal/day)	0.998	0.997–0.999	<0.01*	0.999	0.998–1	<0.01*

eISSN:: 1875-855X
Langue:: Anglais

Périodicité:: 6 fois par an
Sujets de la revue:: Medicine, Assistive Professions, Nursing, Basic Medical Science, other, Clinical Medicine

RSS Feed de la revue

Clinical outcomes of acute respiratory distress syndrome in a university hospital

Article Category: Brief communication (original)

Publié en ligne: 24 oct. 2019

Pages: 263 - 271

DOI: https://doi.org/10.1515/abm-2019-0029

Mots clésacute respiratory distress syndrome, intensive care units, positive pressure respiration

© 2018 Sanguanwong and Kongpolprom, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Figure 1

Characteristics of enrolled patients

Comparison of 28-day mortality of ARDS patients and factors possibly associated with mortality between our study and other studies including ALIEN, LUNG SAFE, PRoVENT, and APRONET

Univariate analysis for 7- and 28-day mortalities

Multivariate analysis for 7- and 28-day mortalities

Mots clés
acute respiratory distress syndrome, intensive care units, positive pressure respiration