Clinical outcomes of acute respiratory distress syndrome in a university hospital
Article Category: Brief communication (original)
Published Online: Oct 24, 2019
Page range: 263 - 271
DOI: https://doi.org/10.1515/abm-2019-0029
Keywords
© 2018 Sanguanwong and Kongpolprom, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.
Background
Mortality rates of acute respiratory distress syndrome (ARDS) are different, depending on severity, etiology, and management.
Objective
To determine 7-day and 28-day mortalities, hospital length of stay (LOS), duration of mechanical ventilation (MV) of ARDS patients, and factors associated with poor outcomes.
Methods
A retrospective study was conducted to review the database of ARDS patients admitted in medical intensive care units (ICUs) at a university hospital between 2010 and 2014. The cases were identified by using International Classification of Diseases, 10th Revision (ICD-10) code-J80 ARDS.
Results
Of 266 patients, 11.7%, 44.4%, and 44% fulfilled mild, moderate, and severe ARDS criteria, respectively. The main cause of ARDS was pneumonia. The 7-day and 28-day mortalities, median LOS, and median MV duration were 31.1%, 69.3%, 18, and 11 days, respectively. Pressure control was the most favorite mode, used with average tidal volume (TV) of 8.63 (2.16) mL/kg ideal body weight (IBW). Recruitment maneuver was most frequently used as adjunctive intervention, whereas prone position was applied to 3.75% of the patients. One-third of the patients received neuromuscular blockades. The median 7-day fluid balance was +6,600 mL. The mean PaO2/FiO2 ratio during the first 3 days, cumulative fluid balance on day 3, and average daily calories during the first week were independent predictors for adjusted 7-day mortality, whereas Acute Physiology and Chronic Health Evaluation (APACHE II) score, fluid balance on day 1, cumulative fluid balance, and average daily calories during the first week were independent predictors for adjusted 28-day mortality.
Conclusions
The 28-day mortality of ARDS was high. In addition, TV and fluid balance were greater than protective limits. These findings indicated the potential improvement of ARDS outcomes in our hospital.