A Multicenter Registry of Patients with Acute Respiratory Distress Syndrome: Physiology and Outcome

Abstract

In a multicenter registry conducted over 2 yr of patients with acute respiratory distress syndrome (ARDS), we enrolled 153 patients and collected data daily for 7 consecutive days and weekly thereafter until death or hospital discharge. The purposes of the registry were (1) to determine whether a more liberal definition of ARDS (PaO2/FIO2 < or = 250; bilateral pulmonary infiltrates within 7 days) than those commonly used would result in enrollment of patients earlier in their clinical course, and (2) to study the clinical course of the syndrome in survivors and nonsurvivors. The mortality rate was 54% and it was significantly greater in older versus younger patients (75% versus 37%) and in septic versus nonseptic patients (60% versus 43%). We found that the definition of ARDS used for the registry resulted in enrollment of patients 1 to 7 days earlier than was the case when other published definitions of ARDS were applied to the patient population. Fewer than 2% of the patients failed to meet one of the nonregistry definitions of ARDS within 7 days. The mortality rate was independent of the definition used to identify ARDS patients. Our results suggest that a more liberal definition of ARDS than those commonly used can result in identification of the same population of patients earlier in their clinical course.

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

“…Th ese fi ndings are concordant with several studies that have shown that the PF ratio measured at the onset of ARDS is not an independent predictor of mortality. [20][21][22][23][24][25] One possible explanation for the lack of the power of the PF ratio to discriminate adverse outcome in ARDS is that the PF ratio is highly variable depending on the ventilator strategy chosen. In one study, standardization of ventilator settings greatly improved risk stratifi cation of ARDS by PF ratio.…”

Review article: Age related alterations in respiratory function — anesthetic considerations

“…In patients with adult respiratory distress syndrome older age is clearly associated with higher mortality rates. 87,88 Similar data specific to mechanical ventilation made necessary by postoperative pulmonary complications are not available. Ely et al 89 prospectively studied whether age represents an independent effect on the outcomes of patients requiring mechanical ventilation after admission to an intensive care unit.…”

Diagnostic and Prognostic Utility of Brain Natriuretic Peptide in Subjects Admitted to the ICU With Hypoxic Respiratory Failure Due to Noncardiogenic and Cardiogenic Pulmonary Edema

“…The differential diagnosis is challenging in cases requiring distinction between cardiogenic pulmonary edema (CPE) and ARDS/acute lung injury (ALI). [1][2][3][4][5] The most widely used clinical definition of ARDS/ALI is based on the acute onset of hypoxemia, chest radiography, risk factors, and a pulmonary capillary wedge pressure (PCWP) < 18 mm Hg, or absence of clinical evidence of elevated left atrial filling pressures. 3 However, clinical estimation of PCWP is notoriously inaccurate, 6 and its measurement requires the performance of right-heart catheterization (RHC) using a Swan-Ganz catheter, which is invasive and costly, 7 and has been associated with neutral 8-10 or potentially adverse clinical outcomes.…”