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Predictors of mortality in ARDS patients referred to a tertiary care centre: a pilot study

Published online by Cambridge University Press:  10 February 2006

Thomas Luecke ,
Elke Muench ,
Harry Roth ,
Ulrike Friess ,
Torsten Paul ,
Katrin Kleinhuber  and
Michael Quintel
Thomas Luecke
Affiliation:
University of Heidelberg, Faculty of Clinical Medicine Mannheim, University Hospital of Mannheim, Department of Anesthesiology and Critical Care Medicine, Germany
Elke Muench
Affiliation:
University of Heidelberg, Faculty of Clinical Medicine Mannheim, University Hospital of Mannheim, Department of Anesthesiology and Critical Care Medicine, Germany
Harry Roth
Affiliation:
University of Heidelberg, Faculty of Clinical Medicine Mannheim, University Hospital of Mannheim, Department of Anesthesiology and Critical Care Medicine, Germany
Ulrike Friess
Affiliation:
University of Heidelberg, Faculty of Clinical Medicine Mannheim, University Hospital of Mannheim, Department of Anesthesiology and Critical Care Medicine, Germany
Torsten Paul
Affiliation:
University of Heidelberg, Faculty of Clinical Medicine Mannheim, University Hospital of Mannheim, Department of Anesthesiology and Critical Care Medicine, Germany
Katrin Kleinhuber
Affiliation:
University of Heidelberg, Faculty of Clinical Medicine Mannheim, University Hospital of Mannheim, Department of Anesthesiology and Critical Care Medicine, Germany
Michael Quintel
Affiliation:
University of Goettingen, Department of Critical Care, Germany
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Abstract

Summary

Background and objective: In order to identify parameters predicting intensive care unit mortality in patients transferred to a specialized tertiary centre because of progressive acute respiratory distress syndrome, an observational pilot study was carried out involving 94 patients. Methods and Results: Forty-one patients (43.6%) died. Survival was defined as intensive care unit discharge. Survivors were younger (32.0 ± 11.8 vs. 39.1 ± 12.4 yr, P = 0.008), at admission they had a lower acute physiology and chronic health evaluation (APACHE) II score (21.7 ± 5.4 vs. 25.4 ± 5.2, P = 0.0009), higher PaO2/FiO2 (122 ± 79 vs. 79 ± 42 mmHg, P = 0.002), lower positive end-expiratory pressure (10.6 ± 3.1 vs. 12.5 ± 3.7 cmH2O, P = 0.02) and a lower Murray score (2.8 ± 0.63 vs. 3.0 ± 0.62, P = 0.04). No differences were observed for tidal volumes and peak inspiratory pressures. Days of hospitalization and mechanical ventilation prior to transferral were not related to survival. Multivariate analysis of variables assessed on admission detected only differences for age (P = 0.014) and APACHE II (P = 0.005). Odds ratio was 1.06 (95% confidence interval (CI): 1.013–1.119) for age and 1.21 (CI: 1.059–1.381) for APACHE II. Multivariate analysis of changes in respiratory parameters, APACHE II and Murray score during the first 3 days after transferral revealed a significant difference only for positive end-expiratory pressure (P < 0.008). Corresponding odds ratio was 2.40 (CI: 1.25–4.58) for an increase of 1 cmH2O/24 h. Conclusion: Age-related mortality in this small, but highly selected group of patients with established ARDS increased early in life even in a population with an overall mean age of 35.1 yr. APACHE II was the only clinical predictor for mortality on admission. The need for a substantial increase in positive end-expiratory pressure after transferral markedly reduced the chance to survive.

Keywords

RESPIRATORY DISTRES SYNDROME, ADULTEXTRACORPOREAL MEMBRANE OXYGENATIONCRITICAL CAREMORTALITY, predictionAPACHE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 5 , May 2006 , pp. 403 - 410
Copyright
2006 European Society of Anaesthesiology

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References

Lewandowski K, Metz J, Deutschmann Cet al. Incidence, severity, and mortality of acute respiratory failure in Berlin, Germany. Am J Respir Crit Care Med 1995; 151: 1121–1125.Google Scholar
Luhr OR, Antonsen K, Karlsson Met al. Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. Am J Respir Crit Care Med 1999; 159: 1849–1861.Google Scholar
Roupie E, Lepage E, Wysocki Met al. Prevalence, etiologies, and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF collaborative group on mechanical ventilation. Intens Care Med 1999; 25: 920–929.Google Scholar
Milberg JA, Davis DR, Steinberg KPet al. Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA 1995; 273: 306–309.Google Scholar
Krafft P, Fridrich P, Pernersdorfer Tet al. The acute respiratory distress syndrome: definitions, severity and outcome. A analysis of 101 clinical investigations. Intens Care Med 1996; 22: 519–529.Google Scholar
Abel SJC, Finney SJ, Brett SJet al. Reduced mortality in association with the acute respiratory distress syndrome (ARDS). Thorax 1998; 53: 292–294.Google Scholar
Lewandowski K, Rossaint R, Pappert Det al. High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporal membrane oxygenation. Intens Care Med 1997; 23: 819–835.Google Scholar
Hickling KG, Walsh J, Henderson SJet al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia. Crit Care Med 1994; 22: 1568–1578.Google Scholar
Amato MBP, Barbas CSV, Medeiros DMet al. Effect of a protective ventilation strategy on mortality in the acute respiratory distress syndrome. New Engl J Med 1998; 338: 347–354.Google Scholar
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes for acute lung injury and the acute respiratory distress syndrome. New Engl J Med 2000; 342: 1301–1308.
Fowler AA, Hamman RF, Zerbe GOet al. Adult respiratory distress syndrome. Prognosis after onset. Am Rev Respir Dis 1985; 132: 472–478.Google Scholar
Sloane PJ, Gee MH, Gottlieb JEet al. A multicenter registry of patients with acute respiratory distress syndrome. Physiology and outcome. Am Rev Respir Dis 1992; 146: 419–428.Google Scholar
Doyle RL, Szaflarsky N, Modin GWet al. Identification of patients with acute lung injury: predictors of mortality. Am J Respir Crit Care Med 1995; 152: 1818–1824.Google Scholar
Ferring M, Vincent JL. Is outcome from ARDS related to the severity of respiratory failure? Eur Respir J 1997; 10: 1297–1300.Google Scholar
Lee J, Turner JS, Morgan CJet al. Adult respiratory distress syndrome: has there been a change in outcome predictive measures? Thorax 1994; 49: 596–597.Google Scholar
Hefner JE, Brown LK, Barbieri CAet al. Prospective validation of an acute respiratory distress syndrome predictive score. Am J Respir Crit Care Med 1995; 152: 1518–1526.Google Scholar
Luhr OR, Karlsson M, Thorsteinsson Aet al. The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation. Intens Care Med 2000; 26: 508–517.Google Scholar
Suchyta MR, Clemmer TP, Elliot CGet al. Increased mortality of older patients with acute respiratory distress syndrome. Chest 1997; 111: 1334–1339.Google Scholar
Gee MH, Gottlieb JE, Albertine KHet al. Physiology of aging related to outcome in the adult respiratory distress syndrome. J Appl Physiol 1990; 69: 822–829.Google Scholar
Bernard G, Artigas RA, Brigham KLet al. The American–European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994; 149: 818–824.Google Scholar
Murray JF, Matthay MA, Luce JMet al. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 1989; 138: 720–723.Google Scholar
Knaus WA, Draper EA, Wagner DPet al. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–829.Google Scholar
Estenssoro E, Dubin A, Laffaire Eet al. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 2002; 30: 2450–2456.Google Scholar
Zilberberg MD, Epstein SK. Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 1998; 157: 1159–1164.Google Scholar
Knaus W, Sun X, Hakim Ret al. Evaluation of definitions for adult respiratory distress syndrome. Am J Respir Crit Care Med 1994; 150: 311–317.Google Scholar
Monchi M, Bellenfant F, Cariou Aet al. Early predictive factors of survival in the acute respiratory distress syndrome. Am J Respir Crit Care Med 1998; 158: 1076–1081.Google Scholar
Navarrete-Navarro P, Ruiz-Bailen M, Rivera-Fernandez Ret al. Acute respiratory distress syndrome in trauma patients: ICU mortality and predicting factors. Intens Care Med 2000; 26: 1624–1629.Google Scholar
Henzler D, Dembinski R, Hawichhorst Ret al. Therapie des akuten Lungenversagens in einem Behandlungszentrum. Anaesthesist 2004; 53: 235–243.Google Scholar
Villar J, Perez-Mendez L, Kacmarek RM. Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome. Intens Care Med 1999; 25: 930–935.Google Scholar
Gattinoni L, Tognoni G, Pesenti Aet al. Effect of prone positioning on the survival of patients with acute respiratory failure. New Engl J Med 2001; 345: 568–573.Google Scholar
Afessa B, Keegan MT, Mohammad Zet al. Identifying potentially ineffective care in the sickest critically ill patients on the third ICU day. Chest 2004; 126: 1905–1909.Google Scholar
Gattinoni L, Pelosi P, Suter PMet al. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease: Different syndromes? Am J Respir Crit Care Med 1998; 158: 3–11.Google Scholar