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Critical Care |

Pulmonary Hypertension Associated With Acute Respiratory Distress Syndrome

Silvio Namendys-Silva, MS; Luis Santos-Martínez, MS; Tomas Pulido, MD; Eduardo Rivero-Sigarroa, MD; José Baltazar-Torres, MD; Guillermo Dominguez-Cherit, MD; Julio Sandoval, MD
Author and Funding Information

Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán and Instituto Nacional de Cancerología, México, Mexico City, Mexico


Chest. 2013;144(4_MeetingAbstracts):376A. doi:10.1378/chest.1695927
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Abstract

SESSION TITLE: Critical Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: The incidence of hypertension pulmonary (PH) in patients with acute respiratory distress syndrome (ARDS) is unknown.The purpose of this study was to describe the incidence and outcome of PH in patients with ARDS.

METHODS: A prospective, observational and descriptive cohort study was approved by the Institutional Review Board and performed from March 2007 to December 2008. All patients aged over 16 who were admitted to the intensive care unit (ICU) with diagnosis of ARDS and a pulmonary artery catheter in situ for hemodynamic monitoring were studied. We used the definition of ARDS proposed by the American-European consensus conference. PH was diagnosed when the the mean pulmonary artery pressure >25 mmHg with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. Patients with evidence of heart disease or lung pathology that could have potentially caused pre-existing PH, or any other disease known to be associated with PH were excluded. Continuous variables were expressed as means ± standard deviation, as medians and interquartile ranges if the distribution was skewed, or as a percentage for categorical variables. Student’s t or the Mann-Whitney U tests were used to compare continuous variables according to the data distribution, and the Chi-squared or Fisher’s exact test was used to compare categorical variables. In all cases, a p value <0.05 was considered statistically significant.

RESULTS: Of the 30 patients enrolled 14 met the criteria for PH, an incidence of 46.6%.The mean age of the patients was 50 years; 14 were female. The most common cause of ARDS was pneumonia (56.6%). The severity of the disease was similar in both groups (patients with and without PH). The mortality rate was 36.6% (11/30); of the patients who died 5 met the diagnostic criteria for PH. The levels of positive end-expiratory pressure and peak inspiratory airway pressure were significantly higher in the PH group, and PaCO2 was significantly higher in the patients who died. There were no differences in the hemodynamic profiles, arterial blood gas parameters or the ventilatory parameters of the patients.

CONCLUSIONS: The incidence of PH in patients with ARDS was 46.6%, and the mortality rate was 36.6%. The degree of PH may be considered mild to moderate.

CLINICAL IMPLICATIONS: We have established that in our group of patients, the level of airway pressure seems to be associated with the existence of PH. The survival in this group of patients is determined by the severity of organ failure on admission to the ICU.

DISCLOSURE: The following authors have nothing to disclose: Silvio Namendys-Silva, Luis Santos-Martínez, Tomas Pulido, Eduardo Rivero-Sigarroa, José Baltazar-Torres, Guillermo Dominguez-Cherit, Julio Sandoval

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