PURPOSE: to determine patient’s demographics, and outcome in ARDS originating from pulmonary disease (ARDSp) versus those originating from extra-pulmonary disease (ARDSexp).
METHODS: Retrospective Study; charts of 52 patients with ARDS in both medical and surgical ICU were reviewed, between January 2001 and June 2002.
RESULTS: There were 19 cases (37 %) in the ARDSp and 33 cases (63 %) in the ARDSexp. The most common etiology of ARDS in the ARDSp was aspiration pneumonia while trauma was the most common in the ARDSexp. The mortality rate in the ARDSp(68%) was significantly higher (P <0.044) than in the ARDSexp (39%). There were no significant differences between the two groups regarding age, severity of illness (APACHE II), Lung Injury Score (LIS), Left ventricular systolic function, total ventilator days, tidal volume per Ideal body weight in kilograms (TV/KG) used, amount of Positive End Expiratory Pressure (PEEP) used, shunt fraction (PaO2/FiO2), and length of hospital stay (LOS).In the pulmonary group: younger age was the only significant difference (P < 0.026) between survivors and non-survivors, there was non-statistically significant trend towards lower TV/KG, and longer LOS in survivors.In the extra-pulmonary group: longer LOS in survivors was the only significant difference (P< 0.05) between survivors and non-survivors.In comparing survivors and non-survivors between the two groups: there were no significant differences in age, sex, APACHE II, LIS, LOS, PaO2/FiO2, PEEP, TV/KG.
CONCLUSION: This study showed higher mortality for patients with ARDS (50%) as compared to other studies in the literature, TV/KG used were higher (11.1± 2.1 cc/kg) than the accepted standard of care nowadays for ALI/ARDS (6 cc/kg). We found significantly higher mortality in the pulmonary group despite the same patient demographics and same ventilator management in both groups. We identified age as a potential contributor to mortality in the pulmonary group, but not in the extra-pulmonary group.
CLINICAL IMPLICATIONS: TV/KG used in the study is unacceptably high especially with the strong evidences that lower tidal volume strategy improves mortality in ARDS. PEEP does not alter mortality in ARDS.
DISCLOSURE: Ehab Daoud, None.