Clinical Profile of Acute Respiratory Distress Syndrome (Ards) in a Tertiary Care Centre/ Hospital

Abstract

BACKGROUND ARDS is considered as the most severe form of acute lung injury, a form of diffuse alveolar injury and a leading cause of death in critical care settings. Aims and Objectives- To analyse the ARDS cases in admitted patients with special reference to risk factors associated with poor prognosis.  To study the aetiology of ARDS.  To study severity and outcome of ARDS cases. MATERIALS AND METHODS This study was an observational study. It included 80 patients of ARDS, which are fulfilling diagnostic criteria according to Berlin definitions 2012. The study period was 1 year. RESULTS In critically ill patients who were hospitalised in Critical Care Units (CCU), the prevalence of ARDS has been estimated at about 5-15% of patients. In our study period, there were 800 admissions with prevalence of ARDS of 12.50%. Our results are consistent with those of Roupie et al, who reported a twice higher mortality (60%) in patients with ARDS than that recorded in patients with mild ALI (31%). Pulmonary infection (37.5%) followed by Dengue (23.75%) were the most common causes for ARDS in this study. In our study, sepsis was the predominant indirect cause of ARDS with 35 out of 80 patients of Dengue, i.e. 19 (23.75%). There was a significant association between severity of ARDS and various aetiological groups with p-value of 0.0001. Patients with ARDS had lower PO2, lower PO2/FiO2 ratio, severe metabolic acidosis, higher serum creatinine, higher blood urea nitrogen and worsened critical scores including GCS scoring, lower systolic blood pressure and lower mean arterial pressure. CONCLUSION 1. Prevalence of acute respiratory distress syndrome is quite common in ICU setting. 2. Pulmonary infection was the most common non-tropical direct cause of ARDS, while sepsis was the most common cause of indirect ARDS. 3. Dengue, Malaria and Leptospirosis were most common tropical causes of ARDS. 4. Factors that showed association with mortality- Aetiology had significant association with outcome.  Anaemia, tachycardia, raised ESR and high WBC count had significant association with outcome.  Deranged serum creatinine and decreased urine output had significant association with outcome.  Low systolic blood pressure and low diastolic blood pressure was significantly associated with poor outcome.  Duration of ventilator support was associated with mortality significantly.  Culture positivity was associated significantly with mortality.