Causes and timing of death in patients with ARDS
Causes and timing of death in patients with ARDS
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DOI：
10.1378/chest.128.2.525
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发表时间：
2005-08-01
期刊：
影响因子：
9.6
通讯作者：
Steinberg, KP
中科院分区：
文献类型：
--
作者：
Stapleton, RD;Wang, BM;Steinberg, KP
背景资料：自20世纪80年代初以来，ARDS患者的病死率有所下降，但原因尚不清楚。设计和方法：使用相同的ARDS和器官衰竭定义，我们分析了1982年（n = 46），1990年（n = 112），1994年（n = 99），结果：总病死率从1981-1982年的68%下降到1996年的29%，自20世纪90年代中期以来趋于稳定（趋势p = 0.001）。脓毒症综合征伴多器官衰竭仍然是最常见的死亡原因（30 - 50%），而呼吸衰竭导致的死亡比例很小（13 - 19%）。死亡原因的分布没有随着时间的推移而改变。在研究期间，死亡时间没有变化：26 - 44%的死亡发生在早期（ARDS发作后< 72小时），56 - 74%发生在晚期（ARDS发作后> 72小时）。然而，在过去的20年中，生存率的增加完全是由存在创伤和其他ARDS危险因素的患者造成的，而那些危险因素是脓毒症的患者的生存率没有改变。此外，在我们的机构中，这些患者的生命支持撤回的频率比过去明显增加，撤回支持的患者的死亡中位时间缩短。结论：虽然这些结果不能解释ARDS的总体病死率下降，他们确实指出脓毒症综合征仍然是死亡的主要原因，并建议未来提高生存率的治疗应着眼于减少并发症。败血症
Background: Since the early 1980s, case fatality of patients with ARDS has decreased, and explanations are unclear.Design and methods: Using identical definitions of ARDS and organ failure, we analyzed consecutive cohorts of patients meeting syndrome criteria at our institution in 1982 (n = 46), 1990 (n = 112), 1994 (n = 99), and 1998 (n = 205) to determine causes and timing of death.Results: Overall case fatality has decreased from 68% in 1981-1982 to a low of 29% in 1996, plateauing since the mid-1990s (p = 0.001 for trend). Sepsis syndrome with multiple organ failure remains the most common cause of death (30 to 50%), while respiratory failure causes a small percentage (13 to 19%) of deaths. The distribution of causes of death has not changed over time. There was no change in the timing of death during the study periods: 26 to 44% of deaths occurred early (< 72 h after ARDS onset), and 56 to 74% occurred late (> 72 h after ARDS onset). However, the increased survival over the past 2 decades is entirely accounted for by patients who present with trauma and other risk factors for their ARDS, while survival for those patients whose risk factor is sepsis has not changed. Additionally, withdrawal of life support in these patients is now occurring at our institution significantly more frequently than in the past, and median time until death has decreased in patients who have support withdrawn.Conclusions: While these results do not explain the overall case fatality decline in ARDS, they do indicate that sepsis syndrome remains the leading cause of death and suggest that future therapies to improve survival be targeted at reducing the complications of sepsis.