Mortality and associated factors in patients with acute respiratory distress syndrome (ARDS) in a university hospital

Abstract

Introduction: acute respiratory distress syndrome (ARDS) is the most serious manifestation of acute pulmonary compromise. Currently no data are available to document the factors associated with mortality in our environment.

Study Design: retrospective cohort study.

Objective: to describe the factors associated with mortality in adult patients hospitalized in critical care unit with ARDS from January 2007 to December 2011.

Methods: Data were collected with regard to causes of ARDS, hospital and ICU stay, critical illness severity and vital status at discharge. Logistic regression analysis was performed to determine factors independently associated with hospital mortality.

Results: 141 patients with ARDS were analyzed; the median age was 44 years and 62.9% were men. The first cause of ARDS was septic shock of pulmonary origin in 49.6% and APACHE II had a median of 18. The median PaO2/FIO2 at the beginning of ARDS was 91.5 and at 72 hours was 125. The median PEEP required at the initiation of mechanical ventilation was 10 cmH2O and at 72 hours 12. The ICU stay was 13 days and hospital mortality was 54%. Factors associated with mortality were the shock of pulmonary origin (OR = 2.45; 95% CI = 1.04-5.77) and APACHE II (OR = 1.05 per point, 95% CI = 1.003-1.1). PEEP level equal to or less within 72 hours acted as a protective factor (OR = 0.36; 95% CI = 0.16-0.82).

Conclusions: ARDS has a high mortality in our environment and the factors most strongly associated with this mortality are dependent on the underlying disease and the intensity of biological response to it.