Evaluation of prognostic indices based on pulmonary and hemodynamic variables in patients with adult respiratory distress syndrome (ARDS).

Abstract

Patients with established ARDS have a high mortality rate. We continuously monitored hemodynamic and respiratory parameters of 30 patients in our ICU, all had acute respiratory failure during admission then progressively developed ARDS. We compared demographic characteristics, APACHE II (acute physiology and chronic health evaluation) score, ALI (acute lung injury) score, associated MSOF (multiple systems organ failure) in the disease process, pulmonary variables, and hemodynamic variables between survivors and nonsurvivors. Six of the 12 female patients and two of the 18 male patients survived. Our female patients had a better outcome than the males (P < 0.02); and, those who were younger than 35 years old and those who had less than two organ failures during the evolution of ARDS also had a better outcome (P < 0.001 vs. P < 0.03). After ARDS had developed, there were significant differences between survivors and nonsurvivors in the APACHE II score (P < 0.03), serum albumin level (P < 0.02), mean airway pressure (P < 0.05), PCWP (P < 0.02) and SaO2 (P < 0.02). Having a higher APACHE (> or = 15, P < 0.003), lower serum ablumin level (Alb < 2.5 gm/dl, P < 0.04), higher mean airway pressure (> or = 25 cm H2O, P < 0.04), higher PCWP (> or = 14 mmHg, P < 0.006), and lower SaO2 (< 93%, P < 0.002) predicted a poorer outcome. All patients received PEEP therapy and there were no significant differences between survivors and nonsurvivors in the PEEP level applied, either at the beginning of respiratory failure, or after development of ARDS. But those who had PEEP of 6 cm H2O or higher applied at the beginning of respiratory failure and those had PEEP of less than 10 cm H2O after development of ARDS had a better outcome (P < 0.04 vs. P < 0.05). Nevertheless, more controlled trials are needed before we make any conclusion about PEEP therapy.