title: Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome.
abstract: 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.
authors.affiliation: Hospital de Agudos General San Martin de La Plata de Capital Federal, República, Argentina.
authors.forename: Elisa
authors.initials: E
authors.lastname: Estenssoro
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Dubin
authors.forename: Enrique
authors.initials: E
authors.lastname: Laffaire
authors.forename: Héctor
authors.initials: H
authors.lastname: Canales
authors.forename: Gabriela
authors.initials: G
authors.lastname: Sáenz
authors.forename: Miriam
authors.initials: M
authors.lastname: Moseinco
authors.forename: Mario
authors.initials: M
authors.lastname: Pozo
authors.forename: Alejandro
authors.initials: A
authors.lastname: Gómez
authors.forename: Natalio
authors.initials: N
authors.lastname: Baredes
authors.forename: Gustavo
authors.initials: G
authors.lastname: Jannello
authors.forename: Javier
authors.initials: J
authors.lastname: Osatnik
mesh_terms: 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