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After Lung Protective Ventilation Strategy, What Are the Outcome Improvement Predictors in Acute Respiratory Distress Syndrome? Utilizing the New Diagnostic Criteria of Berlin FREE TO VIEW

Abdelbaset Saleh, MD; Magda Ahmad, MD; Nabil Awadalla, MD; Ahmad Abdelateif, RCP
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Chest Department, Faculty of Medicine, Mansoura University, Al-Mansoura, Egypt

Chest. 2014;146(4_MeetingAbstracts):212A. doi:10.1378/chest.1992172
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SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM

PURPOSE: To identify outcome improvement factors in Acute Respiratory Distress Syndrome (ARDS) patients according to the new Berlin diagnostic criteria and managed with lung protective ventilation.

METHODS: A retrospective observational study was conducted on a total number of 41 moderate and severe ARDS patients diagnosed according to Berlin criteria for definition of ARDS 2012. Demographic, clinical, laboratory and radiologic criteria were assessed for all patients and samples from sputum, blood, and urine were taken and sepsis work up were done at the first day of hospitalization and on the day of diagnosis of Ventilator associated pneumonia. Also fluid balance was assessed by the end of the first week of ventilation. Significant factors of survival improvement and predictors of mortality were identified in bivariate analysis. ROC curves were done to evaluate the accuracy of some factors affecting survival.

RESULTS: ARDS mortality in this study was less than 30%. In the bivariate analysis, 25 variables were significantly correlated with mortality. On admission to ICU, the non-survived patients were had tachypnea, tachycardia and lower DBP, Pao2/Fio2, PO2, O2sat and HCO3 and higher FIO2 and PCO2. Also, they had lower serum Na level and higher K, pH and creatinine levels compared with survived patients. CRP and GCS were significantly lower in non-survived patients. On the other hand, the average fluid balance in non-survived patients was positive and significantly higher than the patients who survived. Good general conditions indicated by GCS above 9 was the most accurate improvement prediction factor followed by proper oxygenation indicated by PaO2/FiO2 ratio above 90. On the other hand, delay in ICU admission more than 6 days, deterioration of serum creatinine level above 1.5mg/dl on the first day of admission and positive fluid balance above 2690 (ml) were accurate predicting factors of mortality.

CONCLUSIONS: ARDS mortality rate was improved after lung protective ventilation strategy. Early diagnosis and ICU admission, keeping patients' on PaO2/FiO2 ratio above 90, GCS above 9, negative fluid balance and serum creatinine level less than 1.5mg/dl beside prevention of HAP were outcome improving factors in ARDS.

CLINICAL IMPLICATIONS: Early identification of these factors will help to assess prognosis, improve practice and aid in timely management. We hypothesized that this ventilation strategy may attenuate the predictive value of previously identified pulmonary specific measures

DISCLOSURE: The following authors have nothing to disclose: Abdelbaset Saleh, Magda Ahmad, Nabil Awadalla, Ahmad Abdelateif

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