Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome
Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome
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DOI：
10.1097/00003246-200211000-00008
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发表时间：
2002-11-01
影响因子：
8.8
通讯作者：
Osatnik, J
中科院分区：
文献类型：
--
作者：
Estenssoro, E;Dubin, A;Osatnik, J
目标。前瞻性评估阿根廷4个重症监护室急性呼吸窘迫综合征的发病率、病因、生理和临床特征、死亡率及其预测因素。前瞻性初始队列设置。教学医院的四个普通重症监护室。患者：1999年1月3日至2000年1月6日期间连续入院的所有符合欧美急性呼吸窘迫综合征共识会议标准的成年患者。干预措施:没有。测量结果及主要结果：235例患者出现急性呼吸窘迫综合征，217例患者存活，存活时间为1024h；进一步分析。主要危险因素为：败血症（44%，包括65例肺炎）、休克（15%）、外伤（11%）、胃误吸（10%）、其他（34%）。入院时，非幸存者的急性生理和慢性健康评估11、序事性器官衰竭评估和McCabe评分明显较高，氧合和pH值较低。在第一周，Pao(2)/Fio(2)、序事性器官衰竭评估、pH值、碱性过量和驱动压力在幸存者和非幸存者之间始终存在差异。医院死亡率为58%。三分之一的患者早亡。主要死亡原因为多脏器功能障碍综合征、败血症、感染性休克；难治性低氧血症少见。与死亡率独立相关的因素是第3天的器官功能障碍、第3天的Pao(2)/Fio(2)和McCabe评分。急性呼吸窘迫综合征是该队列中常见的综合征。败血症是其主要病因，肺炎是最常见的单一诊断。死亡率很高，但与最近包括严重合并症的系列相似。入院后72小时死亡的独立预测因子强调了肺外因素和肺部因素以及先前存在的严重疾病的重要性。
Objective. To assess prospectively acute respiratory distress syndrome incidence, etiologies, physiologic and clinical features, and mortality and its predictors in four intensive care units in Argentina.Design. Prospective inception cohort.Setting. Four general intensive care units in teaching hospitals.Patients: All consecutive adult patients admitted between January 3, 1999, and January 6, 2000, that met the criteria of the American- European Consensus Conference for acute respiratory distress syndrome.Interventions: None.Measurements and Main Results: A total of 235 patients developed acute respiratory distress syndrome, and 217 survived for >24 hrs; these were further analyzed. Main risk factors were: sepsis (44%, including 65 pneumonia cases), shock (15%), trauma (11%), gastric aspiration (10%), and other (34%). At admission, nonsurvivors had significantly higher Acute Physiology and Chronic Health Evaluation 11, Sequential Organ Failure Assessment and McCabe scores, and lower oxygenation and pH. During the first week, Pao(2)/Fio(2), Sequential Organ Failure Assessment, pH, base excess, and driving pressure consistently discriminated between survivors and nonsurvivors. Hospital mortality was 58%. One third of patients died early. Main causes of death were multiple organ dysfunction syndrome, sepsis, and septic shock; refractory hypoxemia was uncommon. Factors independently associated with mortality were organ dysfunctions on day 3, Pao(2)/Fio(2) on day 3, and McCabe score.Conclusions. Acute respiratory distress syndrome was a frequent syndrome in this cohort. Sepsis was its leading cause, and pneumonia was the most common single diagnosis. Mortality was high but similar to most recent series that included serious comorbidities. Independent predictors of death 72 hrs after admission emphasize the importance of both extrapulmonary and pulmonary factors together with preexisting severe illnesses.