Abstract
IntroductionAcute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. To date there is no effective pharmacological therapy. Aspirin therapy has recently been shown to reduce the risk of developing ARDS, but the effect of aspirin on established ARDS is unknown.MethodsIn a single large regional medical and surgical ICU between December 2010 and July 2012, all patients with ARDS were prospectively identified and demographic, clinical, and laboratory variables were recorded retrospectively. Aspirin usage, both pre-hospital and during intensive care unit (ICU) stay, was included. The primary outcome was ICU mortality. We used univariate and multivariate logistic regression analyses to assess the impact of these variables on ICU mortality.ResultsIn total, 202 patients with ARDS were included; 56 (28%) of these received aspirin either pre-hospital, in the ICU, or both. Using multivariate logistic regression analysis, aspirin therapy, given either before or during hospital stay, was associated with a reduction in ICU mortality (odds ratio (OR) 0.38 (0.15 to 0.96) P = 0.04). Additional factors that predicted ICU mortality for patients with ARDS were vasopressor use (OR 2.09 (1.05 to 4.18) P = 0.04) and APACHE II score (OR 1.07 (1.02 to 1.13) P = 0.01). There was no effect upon ICU length of stay or hospital mortality.ConclusionAspirin therapy was associated with a reduced risk of ICU mortality. These data are the first to demonstrate a potential protective role for aspirin in patients with ARDS. Clinical trials to evaluate the role of aspirin as a pharmacological intervention for ARDS are needed.
Highlights
Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity
Aspirin exposure was not associated with an impact upon mortality in the univariate analysis (Table 2), in a multiple logistic regression analysis, treatment with aspirin was associated with a significantly lower intensive care unit (ICU) mortality compared with patients who had no aspirin exposure (OR 0.38 (0.15 to 0.96); P = 0.04)
Using multivariate analysis in patients with ARDS, we found aspirin was an independent factor associated with a reduction in risk of death within ICU, whilst the use of vasopressors and acute physiology and chronic health evaluation (APACHE) II score at ICU admission correlated with increased risk of ICU death
Summary
Acute respiratory distress syndrome (ARDS) is a common clinical syndrome with high mortality and long-term morbidity. Acute respiratory distress syndrome (ARDS) is a common devastating clinical syndrome characterised by life-threatening hypoxaemic respiratory failure often requiring mechanical ventilation and frequently leading to multiple organ failure. ARDS is an inflammatory condition characterised by neutrophil-mediated [4,5] and macrophage-mediated [6] injury. This uncontrolled local inflammatory response causes alveolar epithelial and capillary endothelial barrier damage, increasing its permeability. This allows the accumulation of an inflammatory infiltrate, and proteinaceous fluid within the alveolar space (non-cardiogenic pulmonary oedema) that contributes to profound hypoxaemia. There are few effective interventions for ARDS [8,9], and these primarily involve limiting ventilator-induced lung injury with low tidal volume
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