Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome.
OBJECTIVE
To assess prospectively acute respiratory distress syndrome incidence, etiologies, physiologic and clinical features, and mortality and its predictors in four intensive care units in Argentina.


METHODS
Prospective inception cohort.


METHODS
Four general intensive care units in teaching hospitals.


METHODS
All consecutive adult patients admitted between January 3, 1999, and January 6, 2000, that met the criteria of the American-European Consensus Conference for acute respiratory distress syndrome.


METHODS
None.


RESULTS
A total of 235 patients developed acute respiratory distress syndrome, and 217 survived for >24 hrs; these were further analyzed. Main risk factors were: sepsis (44%, including 65 pneumonia cases), shock (15%), trauma (11%), gastric aspiration (10%), and other (34%). At admission, nonsurvivors had significantly higher Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment and McCabe scores, and lower oxygenation and pH. During the first week, Pao2/Fio2, Sequential Organ Failure Assessment, pH, base excess, and driving pressure consistently discriminated between survivors and nonsurvivors. Hospital mortality was 58%. One third of patients died early. Main causes of death were multiple organ dysfunction syndrome, sepsis, and septic shock; refractory hypoxemia was uncommon. Factors independently associated with mortality were organ dysfunctions on day 3, Pao2/Fio2 on day 3, and McCabe score.


CONCLUSIONS
Acute respiratory distress syndrome was a frequent syndrome in this cohort. Sepsis was its leading cause, and pneumonia was the most common single diagnosis. Mortality was high but similar to most recent series that included serious comorbidities. Independent predictors of death 72 hrs after admission emphasize the importance of both extrapulmonary and pulmonary factors together with preexisting severe illnesses.
Estenssoro
Elisa
E
Hospital de Agudos General San Martin de La Plata de Capital Federal, República, Argentina.
Dubin
Arnaldo
A
Laffaire
Enrique
E
Canales
Héctor
H
Sáenz
Gabriela
G
Moseinco
Miriam
M
Pozo
Mario
M
Gómez
Alejandro
A
Baredes
Natalio
N
Jannello
Gustavo
G
Osatnik
Javier
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012307:Risk Factors