Acute respiratory distress syndrome in a University Hospital ICU in Japan

Objective

To determine prognostic factors for and the outcome of acute respiratory distress syndrome (ARDS) in our ICU.

Method

The American-European consensus conference definition [1] was used for ARDS diagnosis. Thirty-three (2.1%) of 1588 patients admitted to the ICU met the criteria for ARDS. Mechanical ventilation with PEEP was performed for all patients with ARDS. Steroid pulse therapy (60%), nitric oxide inhalation (21%), surfactant replacement (9%), and neutrophil elastase inhibitor administration (24%) were also used. For determination of prognostic factors of ARDS, mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and multiple organ dysfunction score (MODS) [2] excluding the Glasgow Coma Score were measured and compared with outcome.

Results

There were 22 men and 11 women aged 61 ± 12 years. The mortality rate of ARDS was 73%. Sepsis was the main cause of ARDS accounting for 73% of cases. All ARDS patients with septic shock (n = 9) and with sterile shock [3] (n = 4) died. The patients with shock had higher MODS compared to those without shock with mortality rate 55%. There were no significant differences in mPAP and PVR between survivor and nonsurvivors. ARDS patients who had high MODS, especially those with low PaO₂/FIO₂ and high pressure-adjusted heart rate, 5 days after the onset of ARDS had a poor prognosis.

Conclusion

Shock and MODS, but not pulmonary hypertension, are important as prognostic factors for ARDS.