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research
Modelling thirty-day mortality in the acute respiratory distress syndrome (ARDS) in an adult ICU
Authors
Abel S.J.
Abraham E.
+45 more
Altman D.G.
Altman D.G.
Barnard J.
Bernard G.R.
Bersten A.D.
Bone R.C.
Brochard L.
Charlson M.E.
Chevret S.
Clark T.G.
Concato J.
Croce M.A.
de Bruijne M.H.
Dempster A.P.
Doyle R.L.
Dreyfuss D.
Esteban A.
Fuhrman B.P.
Gould A.L.
Haley R.W.
Hickling K.G.
Hilsenbeck S.G.
Hosmer D.W.
Irala-Estevez J.
Jardin F.
Klein J.P.
Knaus W.A.
Knaus W.A.
Knaus W.A.
Krafft P.
Lagakos S.W.
Lindsey J.K.
Little R.
Luce J.M.
Luhr O.R.
Mander A.
Monchi M.
Murray J.F.
Rocco T.R.
Stewart T.E.
Suntharalingam G.
The ARDS Network Authors For The ARDS Network
Thompson B.T.
Wolfe R.A.
Zhou M.
Publication date
1 January 2004
Publisher
'SAGE Publications'
Doi
Cite
Abstract
Publisher's copy made available with the permission of the publisher © Australian Society of AnaesthetistsVariables predicting thirty-day outcome from Acute Respiratory Distress Syndrome (ARDS) were analysed using Cox regression structured for time-varying covariates. Over a three-year period, 1996-1998, consecutive patients with ARDS (bilateral chest X-ray opacities, PaO₂/FiO₂ ratio of <200 and an acute precipitating event) were identified using a prospective computerized data base in a university teaching hospital ICU. The cohort, 106 mechanically ventilated patients, was of mean (SD) age 63.5 (15.5) years and 37% were female. Primary lung injury occurred in 45% and 24% were postoperative. ICU-admission day APACHE II score was 25 (8); ARDS onset time from ICU admission was 1 day (median: range 0-16) and 30 day mortality was 41% (95% CI: 33%-51%). At ARDS onset, PaO₂/FiO₂ ratio was 92 (31), 81% had four-quadrant chest X-ray opacification and lung injury score was 2.75 (0.45). Average mechanical ventilator tidal volume was 10.3 ml/ predicted kg weight. Cox model mortality predictors (hazard ratio, 95% CI) were: APACHE II score, 1.15 (1.09-1.21); ARDS lag time (days), 0.72 (0.58-0.89); direct versus indirect injury, 2.89 (1.45-5.76); PaO₂/FiO₂ ratio, 0.98 (0.97-0.99); operative versus non-operative category, 0.24 (0.09-0.63). Time-varying effects were evident for PaO₂/FiO₂ ratio, operative versus non-operative category and ventilator tidal volume assessed as a categorical predictor with a cut-point of 8 ml/kg predicted weight (mean tidal volumes, 7.1 (1.9) vs 10.7 (1.6) ml/kg predicted weight). Thirty-day survival was improved for patients ventilated with lower tidal volumes. Survival predictors in ARDS were multifactorial and related to patient-injury-time interaction and level of mechanical ventilator tidal volume.J. L. Moran, P. J. Solomon, V. Fox, M. Salagaras, P. J. Williams, K. Quinlan, A. D. Berstenhttp://www.aaic.net.au/Article.asp?D=200332
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