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Prognostic factors in severe ARDS-patients

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Aim of the study

To evaluate the prognostic value of different parameters on the outcome of conventionally treated ARDS-patients, admitted to the ICU as potential extra-corporal-membrane-oxygenation (ECMO) candidates.

Material and methods

Between 1995 and 1999, 115 patients with severe ARDS were transferred to the ICU of a University hospital as potential ECMO candidates. 22 patients underwent ECMO-therapy, 6 died soon after admission. 66 patients were treated with conventional therapy. In these 66 patients, we evaluated epidemiological characteristics, days in hospital before admission, days on the ventilator before admission, length of ICU-stay, days on the ventilator at the ICU, ventilator parameters (PEEP, peak airway pressure, mean airway pressure, PaO2/FiO2-ratio, compliance), biochemical parameters (haemoglobin, hematocrit, lactate, CRP, leukocytes, thrombocytes, creatinine), APACHE II and fluid balance on admission (1), 24 (2), 48 (3) and 72 (4) h after admission. Data are given as mean ± SD. The Mann-Whitney U-test was used to identify significant differences between the groups.

Results

Forty-four of 66 patients survived, with an average Glasgow-outcome-scale of 3.88± 0.44. The mortality rate was 33% and mainly caused by MODS due to sepsis. None of the patients died of hypoxemia. The non-survivors were significantly older (44.64 ± 21.2 years) than the survivors (32.39 ± 12.2 years, P<0.001), and had more concomitant diseases (28 vs 12), and a longer course of disease before hospitalisation (7.62 ± 9.95 vs 2.90 ± 10.33 days, P<0.005). For hospital stay (12.54 ± 9.99 vs 10.0 ± 7.88 days) or days on the ventilator before transfer (8.74 ± 9.41 vs 6.98 ± 6.48 days) no difference could be shown. After admission the nonsurvivor group received more days of controlled ventilation (9.71 ± 5.81 days) than the survivor group (5.21 ± 5.69 days, P<0.001), with regard to ICU stay no difference could be shown (19.09 ± 14.99 vs 18.34 ± 11.31 days, ns). Significant differences between survivors and nonsurvivors are shown in Table 1.

No significant differences could be demonstrated for biochemical parameters, fluid balance, and compliance.

Conclusion

High APACHE II values, high PEEP, peak, and mean-airway-pressure levels and a low PaO2/FiO2-ratio are demonstrated to be of high prognostic value in a non-ECMO treated severe ARDS population. None of the patients included in this survey died of hypoxemia, poor outcome was mainly determined by MODS due to sepsis.

Table 1 Significant differences between survivors and non-survivors, level of significance P<0.001

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Friess, U., Münch, E., Roth, H. et al. Prognostic factors in severe ARDS-patients. Crit Care 4, P132 (2000). https://doi.org/10.1186/cc852

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Keywords

  • Lactate
  • Creatinine
  • Biochemical Parameter
  • Airway Pressure
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