Is outcome from ARDS related to the severity of respiratory failure? M. Ferring, J-L. Vincent. ©ERS Journals Ltd 1997.ABSTRACT: The characteristics and outcome of acute respiratory distress syndrome (ARDS) may have changed with time. Some studies have reported that mortality is more commonly related to the development of sepsis/multiple organ failure (MOF), and others that it is related to the severity of acute respiratory failure (ARF). The present study evaluates the relative importance of the two phenomena in a large series of patients.The clinical and biological data of all patients who developed ARDS during a 26 month period (January 1993 until February 1995) in our intensive care unit (ICU) were reviewed retrospectively.A total of 129 patients developed ARDS during the study period, representing an incidence of 2.4% of all ICU admissions. The mortality rate was 52%. The primary cause of death was sepsis/MOF (49%), followed by respiratory failure (16%), cardiac failure or arrhythmias (15%), neurological failure (10%), and other causes (8%). The mortality rate was related to age and degree of organ failure. MOF was not always a cause of late death, since half the deaths occurred within 5 days after admission. In addition, mortality was higher in septic than in nonseptic patients, and lower in trauma and surgical than in medical patients.We conclude that sepsis/multiple organ failure is still the most common cause of death in acute respiratory distress syndrome. Improvements in outcome of acute respiratory distress syndrome may depend more on treatment of sepsis and multiple organ failure than on oxygenation measures.

A multifaceted intervention can substantially decrease the number of requests for arterial blood gas analysis and increase their appropriateness without affecting patient safety.

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Purpose: The objective of the study was to compare a bedside whole blood activated partial thromboplastin time (aPTT) performed by a point of care (POC) apparatus (CoaguCheck® Pro) in surgical intensive care (SIC) patients with a conventional aPTT obtained from the central laboratory.Methods: The prospective concomitant measurements of the two aPTT were performed in 233 samples from 46 consecutive patients admitted after cardiovascular or major abdominal surgery.Results: Inter-operator, inter-instrument and inter-cartridge variability of the new device measured in three healthy volunteers and in nine patients in stable condition (controls) was low (F test: P=0.86). The agreement by Bland and Altman between POC and central laboratory aPTT (-20.2 ± 18.8 sec) was not satisfactory. The agreement between POC and central laboratory aPTT in patients after surgery was worst (-17 ± 33.1 sec). Heparin treatment or timing of blood sampling after intensive care admission (<48 hr vs >48 hr) did not influence the agreement. The correlation between POC or central laboratory aPTT and anti-factor Xa activity was poor (r 2 0.077 and 0.181 respectively). The test which correlated the best to heparin doses was anti-factor Xa activity (r 2 0.714).Conclusion: POC aPTT and central laboratory aPTT showed a poor agreement in SIC patients admitted after surgery, although in healthy volunteers or in control patients, this agreement was better. The best test to monitor heparin treatment in this setting was anti-factor Xa activity.

The use of induced hypertension in head injury patients is controversial. We present the case of a 19-year-old man admitted with severe head trauma after a road accident and describe the beneficial effects that increasing arterial blood pressure had on the cerebral perfusion pressure, cerebral blood flow and jugular bulb oxygen saturation in this patient.