Characteristics and Clinical Outcomes of Acute Respiratory Distress Syndrome (ARDS) in Medical Intensive Care Unit

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Published: Apr 27, 2018
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Medical Physician, Professional Level, Department of Pulmonary and Critical care Medicine, Buriram Hospital, Buriram, Thailand

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Narin Chindavech
Medical Physician, Professional Level, Department of Pulmonary and Critical care Medicine, Buriram Hospital, Buriram, Thailand

Abstract

Backgrounds: There are very few studies in diagnosis and pattern of ARDS patients in Thailand. The various causes reported for ARDS have been associated with a variety of tropical infections. Therefore, the aim of this study was to assess the clinical characteristics and factors predicting outcomes among ARDS patients.
Objective: To establish the clinical characteristics of ARDS and determine the effect of ARDS to organ dysfunctions, clinical outcomes, prognosis among those patients.
Methods: Cross-sectional observational study was done over 1 year from October 2013 to December 2014 in medical intensive care unit, Buriram hospital. Baseline characteristics, etiology, disease severity, length of hospital stay and mortality were collected. Factors and severity of organ dysfunctions significantly influenced mortality were examined.
Results: Eighty of 605 (13.2%) ARDS patients were enrolled. Mean age was 45.9±15.2, 52 (65.0%) were men. Mean Pa0/Fi02 was 145.7 and severe ARDS (Pa0/Fi02< 100) was 31.3%. PEEP level was 8.4± 3.2 cmH20. Mean APACHEII was 35.1±4.5, SAPII 66.5±8.2, SOFA dayl 14.5±3.0, SOFA day3 10.8±5.1, lactate 8.9±3.8, SCV02 75.7±14.4, baseline creatinine 3.8±2.4, 91.3% of patients were in AKIN stage III, 89.0% received CRRT. Septic shock, bacterial pneumonia and tropical infections were main diagnosis causes of ARDS (38.8%, 31.2% and 20.0% respectively). Length of hospital stay was 12.5±11.9 days, intensive care unit stay 6.2±7.2, mechanical ventilator free day 6.3±9.0. Additionally, in hospital mortality was 43.8% and 28-day mortality was 46.3%. Tidal volumes in both survivor and non survivor were higher than lung protective ventilation strategy recommendation (7.7 vs 8.5 ml/predicted body weight, respectively, p<0.05). Pulmonary complications included diffuse pulmonary hemorrhage. Moreover, patients with presence of septic shock, lactic acidosis, multiple organ failures especially acute kidney injury had a significantly higher mortality rate (p<0.05).
Conclusions: Septic shock, bacterial pneumonia and tropical infections were significant risks in the development of ARDS patients in northeastern part of Thailand.

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How to Cite
Chindavech, N. (2018). Characteristics and Clinical Outcomes of Acute Respiratory Distress Syndrome (ARDS) in Medical Intensive Care Unit. MEDICAL JOURNAL OF SISAKET SURIN BURIRAM HOSPITALS, 30(2), 71–84. retrieved from https://he02.tci-thaijo.org/index.php/MJSSBH/article/view/120333
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Vol. 30 No. 2 (2015): May - August 2015
Section
Original Articles

References

1. MacCallum NS, Evans TW. Epidemiology of acute lung injury. Curr Opin Crit Care 2005;11:1:43.

2. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005:353:16:1685.

3. Estenssoro E, Dubin A, Laffaire E, Canales H, Saenz G, Moseinco M, Pozo M, Gomez A, Baredes N, Jannello G, Osatnik J. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 2002;30:11:2450.

4. Bersten AD, Edibam C, Hunt T, Moran J, Australian and New Zealand Intensive Care Society Clinical Trials Group. Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian States. Am J Respir Crit Care Med 2002;165:4:443.

5. Villar J, Blanco J, Anon JM, Santos- Bouza A, Blanch L, Ambros A, Gandia F, Carriedo D, Mosteiro F, Basaldua S, Fernandez RL, Kacmarek RM, ALIEN Network. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med 2011)37:12:1932.

6. Wang CY, Calfee CS, Paul DW, Janz DR, May AK, Zhuo H, Bernard GR, Matthay MA, Ware LB, KangelarisKN. One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome. Intensive Care Med 2014 Mar;40:3: 388-96. Epub 2014 Jan 17.

7. Phua J, Badia JR, Adhikari NKJ, et al. Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time? A Systematic Review. Am J Respir Crit Care Med 2009;179:220-227.

8. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:3 Pt1:818.

9. Artigas A, Bernard GR, Carlet J, Dreyfuss D, Gattinoni L, Hudson L, Lamy M, Marini JJ, Matthay MA, Pinsky MR, Spragg R, Suter PM. The American-European Consensus Conference on ARDS, part 2: Ventilatory, pharmacologic, supportive therapy, study design strategies, and issues related to recovery and remodeling. Acute respiratory distress syndrome. Am J Respir Crit Care Med 1998;157:4 Pt 1:1332.

10. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. The ARDS Definition Task Force. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA 2012; 20;307:23:2526-33.

11. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. ARDS Definition Task Force. JAMA 2012;307:23:2526-33.

12. Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Slutsky AS, Vincent JL, Rubenfeld GD, Thompson BT, Ranieri VM. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med 2012;38:10:1573-82.

13. Santa Cruz R, Rojas Jl, Nervi R, Heredia R, CiapponiA. High versus low positive end-expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev. 2013;6: CD009098.

14. Meade MO, Cook DJ, Guyatt GH, Slutsky AS, Arabi YM, Cooper DJ, Davies AR, Hand LE, Zhou Q, Thabane L, Austin P, Lapinsky S, Baxter A, Russell J, Skrobik Y, Ronco JJ, Stewart TE, Lung Open Ventilation study Investigators. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end- expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial JAMA 2008;299:6:637.

15. Brower RG, Lanken PN, Maclntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower positive end-expi ratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004 22;351:4:327-36.

16. Mercat A, Richard JC, Vielle B, Jaber S, Osman D, Diehl JL, Lefrant JY, Prat G, Richecoeur J, Nieszkowska A, Gervais C, Baudot J, Bouadma L, Brochard L, Expiratory Pressure (Express) Study Group. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial JAMA 2008;299:6:646.

17. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012 Crit Care Med 2013 ;41:2:580-637.

18. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Networkl, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, de Boisblanc B, Connors AF Jr, Hite RD, HarabinAL. Comparison of two fluid- management strategies in acute lung injury. N Engl J Med 2006; 15;354:24: 2564-75. 21.

19. Reechaipichitkul W, Thavornpitak Y, Sutra S. Burden of adult pneumonia in Thailand: a nationwide hospital admission data 2010. J Med Assoc Thai 2014;97:3:283-92.

20. Champunot R, Tanjatham S, Kerdsin A, Puangpatra P, Wangsai S, Treebupha-chatsakul P, Tasnsuphaswasdikul S, Kiatvitchukul C, Kasyanan H, Yimsabai J, Akeda Y, Kawakami K, Sawanpanyalert P, Dejsirilert S, Oishi K. Impact of pandemic influenza (H1N1) virus-associated community-acquired pneumonia among adults in a tertiary hospital in Thailand. Jpn J Infect Dis 2010;63:4:251-6.

21. Kiatboonsri S, Vathesatogit P, Charoenpan P. Adult respiratory distress syndrome in Thai medical patients. Southeast Asian J Trop Med Public Health 1995;26:4:774-80.

22. Segura ER, Ganoza CA, Campos K, et al. Clinical spectrum of pulmonary involvement in leptospirosis in a region of endemicity, with quantification of leptospiralburden. Clin Infect Dis 2005;40:3:343.

23. Von Ranke FM, Zanetti G, Hochhegger B, Marchiori E. Infectious diseases causing diffuse alveolar hemorrhage in immunocompetent patients: a state-of-the-art review. Lung 2013;191:l:9-18.

24. Niwattayakul K, Homvijitkul J, Niwattayakul S, Khow O, Sitprija V. Hypotension, renal failure, and pulmonary complications in leptospirosis. Ren Fail 2002;24:3:297-305.

25. Park SY, Kim HJ, Yoo KH, Park YB, Kim SW, Lee SJ, Kim EK, Kim JH, Kim YH, Moon JY, Min KH, Park SS, Lee J, Lee CH, Park J, Byun MK, Lee SW, Rlee C, Jung JY, Sim YS. The efficacy and safety of prone positioning in adults patients with acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. J Thorac Dis 2015;7: 3:356-67.