Abstract
Background: Although acute respiratory distress syndrome (ARDS) is a common reason for admission to intensive care units, limited information is available about the epidemiological and clinical characteristics of these patients in Middle Eastern countries. Qatar is a high per capita income country with a large multinational expatriate population. Hamad General Hospital is our main tertiary referral center with the largest medical intensive care unit (MICU). Method: A retrospective cross-sectional study was conducted to extract data from the MICU registry for 101 patients aged >14 years who were admitted with ARDS from January 2015 to December 2015. Results: In 2015, a total of 101 (14.8%) of 682 patients admitted to MICU were diagnosed with ARDS. Males comprised 71.3% and females 28.7%. The mean age of the study population was 44.96 ± 17.97 years. Community-acquired bacterial and viral pneumonia were the most common reasons for ARDS. Crude mortality rate was 35%. The mean age of survivors was 42.09 ± 13.58 years compared with 50.36 ± 16.84 years of non-survivors (p = 0.008). Mortality was associated with increasing age, the Acute Physiologic Assessment and Chronic Health Evaluation II severity score, lower P/F ratio, higher Murray's score, higher PCO2, lower pH, and circulatory support with vasopressors. Preexisting comorbidities did not contribute to high mortality. No difference in mortality was noted with higher versus lower positive end expiratory pressure. The prone position was used in 8% of the cases. Twenty-seven (27%) patients had undergone salvage therapy with extracorporeal membrane oxygenation (ECMO) that resulted in a survival rate of 44%. ARDS was associated with acute renal failure requiring dialysis in 28.7% of the cases, pneumothoraces in 4%, ventilator-associated pneumonia in 7.9%, and central line-associated bloodstream infection in 2%. ARDS led to a prolonged length of stay compared with the average length of stay in MICU. Conclusion: Community-acquired bacterial and viral pneumonia were the most common causes of ARDS at our center. Critical care outcome correlated with the severity of the disease. ECMO was used as salvage therapy in our center.
Highlights
Acute respiratory distress syndrome (ARDS) is a common reason for admission to intensive care units, limited information is available about the epidemiological and clinical characteristics of these patients in Middle Eastern countries
The incidence, clinical course, morbidity, and outcome of acute respiratory distress syndrome (ARDS) in medical patients have not been previously studied in Qatar, a country that is mostly composed of a multinational expatriate population
- Onset over one week or less - Bilateral opacities consistent with pulmonary edema on computed tomography scan or chest radiograph - PF ratio, 300 mm Hg with a minimum of 5 cm H2O positive end-expiratory pressure (PEEP), or continuous positive airway pressure (CPAP) - Above conditions are not fully explained by cardiac failure or fluid overload
Summary
Acute respiratory distress syndrome (ARDS) is a common reason for admission to intensive care units, limited information is available about the epidemiological and clinical characteristics of these patients in Middle Eastern countries. ARDS is a common cause of admission to critical care units It causes significant morbidity and still carries high mortality.[2,3,4] A specialized data registry system ensures the uniformity of diagnostic criteria and the detailed documentation of studied variables. The incidence, clinical course, morbidity, and outcome of ARDS in medical patients have not been previously studied in Qatar, a country that is mostly composed of a multinational expatriate population. The introduction of extracorporeal membrane oxygenation (ECMO) service in 2014 provided a unique perspective of studying the utility of this modality in ARDS management
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