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ARDS before and after the start of mechanical ventilation

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We determined if outcome differed in patients who developed ARDS before and after the institution of mechanical ventilation (MV). A prospective study of 5156 patients who underwent MV >12 h was done in 361 ICUs from 20 countries. Among those patients, 261 (5%) had ARDS at the onset of MV (prior-group), and 313 (6%) developed ARDS 48 h or more after the onset of MV (after-group). The mean time from onset of MV to development of ARDS was 4± 2 days. In the after-group, MV was initiated for the following conditions: sepsis (19%), aspiration (16%), pneumonia (15%), and trauma (15%). MV parameters were similar in both groups. The patient characteristics and outcomes are shown in Table 1 (mean± SD).

Patients who developed ARDS after onset of MV were more likely to have ventilator associated pneumonia (38% vs 26%, P<0.05) and coagulopathy (31% vs 23%, P=0.03). In summary, patients who developed ARDS after the onset of mechanical ventilation were more likely to develop complications, required longer duration of ventilator support, and had higher ICU and hospital mortalities.

Table 1 Results and discussion

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Anzueto, A., Esteban, A., Alía, I. et al. ARDS before and after the start of mechanical ventilation. Crit Care 4 (Suppl 1), P131 (2000).

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