Abstract | CONTEXT: In recent years, protective ventilation with airway pressure limitation has constituted a major advance in acute respiratory distress syndrome treatment and has led to a substantial improvement in prognosis. With this therapeutic rationale, one may even question nowadays whether the severity of respiratory failure still influences mortality. OBJECTIVE: DESIGN AND SETTING: A retrospective study conducted in the medical intensive care unit of a French university hospital from October 1993 to December 2001. PATIENTS A total of 150 acute respiratory distress syndrome patients who were administered uniform protective ventilation with a limited plateau pressure (<30 cm H2O), a low positive end-expiratory pressure (<10 cm H2O), and the same strategy concerning hemodynamic support and dialysis when required. MAIN OUTCOME AND MEASURES: Mean age, general severity index (Simplified Acute Physiologic Score II), number of associated organ failures (Logistic Organ Dysfunction Score), respiratory severity indices (Pao2/Fio2, Lung Injury Severity Score), and severity of initial circulatory failure ( circulatory failure present at admission or that developed during the first 48 hrs) were compared, according to recovery or death, and evaluated by a logistic regression model, which allows simultaneous control of multiple factors. RESULTS: The average mortality rate for the whole group was 38%, with 93 patients recovering after an average duration of mechanical ventilation of 18 +/- 13 days. The major factor significantly and independently associated with probability of dying was the severity of circulatory failure (p =.0001, odds ratio = 10.17). Patients free from initial circulatory failure (39 patients) had a 95% recovery rate. CONCLUSION:
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Authors | Bernard Page, Antoine Vieillard-Baron, Alain Beauchet, Philippe Aegerter, Sebastien Prin, François Jardin |
Journal | Critical care medicine
(Crit Care Med)
Vol. 31
Issue 3
Pg. 765-9
(Mar 2003)
ISSN: 0090-3493 [Print] United States |
PMID | 12626981
(Publication Type: Journal Article)
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Topics |
- APACHE
- Aged
- Female
- France
(epidemiology)
- Hemodynamics
- Hospital Mortality
- Hospitals, University
- Humans
- Logistic Models
- Male
- Middle Aged
- Multiple Organ Failure
(etiology)
- Odds Ratio
- Positive-Pressure Respiration
(methods)
- Predictive Value of Tests
- Prognosis
- Respiratory Distress Syndrome
(classification, complications, mortality, therapy)
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Survival Analysis
- Tidal Volume
- Time Factors
- Treatment Outcome
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