OBJECTIVETo assess the incidence, etiology, physiological and clinical features, mortality, and predictors of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU).

METHODSA retrospective analysis of 5 314 patients admitted to the ICU of our hospital from April 1994 to December 2003 was performed in this study. The ARDS patients were identified with the criteria of the American-European Consensus Conference (AECC). Acute physiology and chronic health evaluation III (APACHE III), multiple organ dysfunction syndrome score (MODS score), and lung injury score (LIS) were determined on the onset day of ARDS for all the patients. Other recorded variables included age, sex, biochemical indicators, blood gas analysis, length of stay in ICU, length of ventilation, presence or absence of tracheostomy, ventilation variables, elective operation or emergency operation.

RESULTSTotally, 131 patients (2.5%) developed ARDS, among whom, 12 patients were excluded from this study because they died within 24 hours and other 4 patients were also excluded for their incomplete information. Therefore, there were only 115 cases (62 males and 53 females, aged 22-75 years, 58 years on average) left, accounting for 2.2% of the total admitted patients. Their average ICU stay was (11.27+/-7.24) days and APACHE III score was 17.23+/-7.21. Pneumonia and sepsis were the main cause of ARDS. The non-survivors were obviously older and showed significant difference in the ICU length of stay and length of ventilation as compared with the survivors. On admission, the non-survivors had significantly higher MODS and lower BE (base excess). The hospital mortality was 55.7%. The main cause of death was multiple organ failure. Predictors of death at the onset of ARDS were advanced age, MODS > or = to 8, and LIS > or = 2.76.

CONCLUSIONSARDS is a frequent syndrome in this cohort. Sepsis and pneumonia are the most common risk factors. The main cause of death is multiple organ failure. The mortality is high but similar to most recent series including severe comorbidities. Based on this patient population, advanced age, MODS score, and LIS may be the important prognostic indicators for ARDS.

Adult ; Aged ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Prognosis ; Respiratory Distress Syndrome, Adult ; mortality ; physiopathology ; Retrospective Studies

PURPOSEThis prospective observational study aims to evaluate the accuracy of dead-space fraction derived from the ventilator volumetric capnography (volumetric CO₂) or a prediction equation to predict the survival of mechanically ventilated patients with acute respiratory distress syndrome (ARDS).

METHODSConsecutive VD/VT measurements were obtained based upon a prediction equation validated by Frankenfield et al for dead-space ventilation fraction: VD/VT = 0.320 + 0.0106 (PaCO₂-ETCO₂)⁺ 0.003 (RR)⁺0.0015 (age) in adult patients who had infection-related severe pneumonia and were confirmed as having ARDS. Here PaCO₂ is the arterial partial pressure of carbon dioxide in mmHg; ETCO₂, the end- tidal carbon dioxide measurement in mmHg; RR, respiratory rate per minute; and age in years. Once the patient had intubation, positive end expiratory pressure was adjusted and after Phigh reached a steady state, VD/VT was measured and recorded as the data for the first day. VD/VT measurement was repeated on days 2, 3, 4, 5 and 6. Meanwhile we collected dead-space fraction directly from the ventilator volu- metric CO₂ and recorded it as Vd/Vt. We analyzed the changes in VD/VT and Vd/Vt over the 6-day period to determine their accuracy in predicting the survival of ARDS patients.

RESULTSOverall, 46 patients with ARDS met the inclusion criteria and 24 of them died. During the first 6 days of intubation, VD/VT was significantly higher in nonsurvivors on day 4 (0.70 ± 0.01 vs 0.57 ± 0.01), day 5 (0.73 ± 0.01 vs. 0.54 ± 0.01), and day 6 (0.73 ± 0.02 vs. 0.54 ± 0.01) (all p =0.000). Vd/Vt showed no significant difference on days 1e4 but it was much higher in nonsurvivors on day 5 (0.45 ± 0.04 vs. 0.41 ± 0.06) and day 6 (0.47 ± 0.05 vs. 0.40 ± 0.03) (both p=0.008). VD/VT on the fourth day was more accurate to predict survival than Vd/Vt. The area under the receiver-operating characteristic curve for VD/VT and Vd/Vt in evaluating ARDS patients survival was day 4 (0.974 ± 0.093 vs. 0.701 ± 0.023, p = 0.0024) with the 95% confidence interval being 0.857-0.999 vs. 0.525-0.841.

CONCLUSIONCompared with Vd/Vt derived from ventilator volumetric CO₂, VD/VT on day 4 calculated by Frankenfield et al's equation can more accurately predict the survival of ARDS patients.

Adult ; Capnography ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; ROC Curve ; Respiration, Artificial ; Respiratory Dead Space ; physiology ; Respiratory Distress Syndrome, Adult ; mortality ; physiopathology

OBJECTIVETo explore the relationship between the adrenal function and the prognosis of acute respiratory distress syndrome (ARDS).

METHODSOne hundred and fifty-eight patients with ARDS were enrolled in this study and were divided into two groups based on the prognosis: survival group and death group. Every patient was given one shot of corticotrophin 250 microg intravenously, plasma cortisol level was detected by radio-immunoassay before the shot (T0) and 30 minutes (T30) and 60 minutes (T60) after. And meanwhile the following parameters in the patients were recorded: age, APACH II, heart rate, mean arterial pressure, PaO(2)/FiO(2), arterial pH, hemoglobin, platelets and WBC, the number of failed organ and 28-day mortality. Relative adrenal insufficiency was defined as the difference between T0 and the highest value of T30 or T60 (DeltaTmax)

RESULTSThe total 28-day mortality was 54.4% (86/158) and the total incidence of relative adrenal insufficiency was 42.7% (68/158). The incidence of relative adrenal insufficiency in death group was significantly higher than that in survival group (62.8% vs 19.4%, P < 0.01). The 28-day mortality in patients complicated with relative adrenal insufficiency was significantly higher than that in those did not (76.5% vs 36.8%, P < 0.001). The area under the ROC curve for DeltaTmax was 0.655. With the multivariate analysis, the number of failed organ and relative adrenal insufficiency were independent risk factors of the death in patients with ARDS.

CONCLUSIONSAdrenal function is valuable in predicting the prognosis of the ARDS.

Adolescent ; Adrenal Glands ; physiopathology ; Adrenal Insufficiency ; etiology ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Respiratory Distress Syndrome, Adult ; complications ; mortality ; physiopathology

To explore the following hypotheses: 1) Gas exchange, Organ failure, Cause, Associated disease (GOCA) score, which reflects both general health and the severity of lung injury, would be a better mortality predictor of acute respiratory distress syndrome (ARDS) than acute physiology and chronic health evaluation (APACHE II) or simplified acute physiology score (SAPS II), which are not specific to lung injury, and lung injury score (LIS) that focuses on the lung injury; 2) the performance of APACHE II and SAPS II will be improved when reinforced by LIS, we retrospectively analyzed ARDS patients (N=158) admitted to a medical intensive care unit for five years. The overall mortality of the ARDS patients was 53.2%. Calibrations for all models were good. The area under the curve of (AUC) of LIS (0.622) was significantly less than those of APACHE II (0.743) and SAPS II (0.753). The AUC of GOCA (0.703) was not better than those of APACHE II and SAPS II. The AUCs of APACHE II and SAPS II tended to further increase when reinforced by LIS. In conclusion, GOCA was not superior to APACHE II or SAPS II. The performance of the APACHE II or SAPS II tended to improve when combining a general scoring system with a scoring system that focused on the severity of lung injury.
APACHE ; Adult ; Aged ; Critical Illness/mortality ; Female ; Humans ; Intensive Care ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; *Pulmonary Gas Exchange ; ROC Curve ; Respiratory Distress Syndrome, Adult/*mortality/*physiopathology ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity ; *Severity of Illness Index ; Survival Analysis

OBJECTIVETo investigate the efficacy of continuous blood purification (CBP) and to explore its mechanism in the treatment of pediatric septic shock.

METHODSNine children weighted 3.1 kg - 14.0 kg with septic shock were treated with continuous veno-venous hemofiltration (CVVH) which is also referred to as CBP with blood access of double-lumen hemodialysis catheter of 6.5 to 8Fr inserted via central vein, hemofilters of Minifilter plus (for children with body weight < 5 kg) or AV400s (for children with body weight > or = 5 kg), child's type extracorporeal circuit vessel and heparin anticoagulation. The replacement solution was delivered pre-dilution after 3 to 4 hours' post-dilution. The blood gas, clinical biochemical items, medium molecule substance (MMS) concentration in blood as well as capillary refill time (CRT), BP, urine output, vasopressors dosage were examined at a set of time points from the beginning to the end of the CVVH.

RESULTSOf the 9 children, 6 had acute renal failure (ARF), 3 had acute respiratory distress syndrome (ARDS), 5 were blood culture positive and all the 9 needed vasopressors to keep BP before CVVH. The blood pH was 7.14 +/- 0.23, base excess (BE) was -11.3 +/- 4.25 mmol/L, MMS was 3532 +/- 519 U/L, PO2/FiO2 was 188 +/- 33, CRT > 5 s, urine output was 0.85 +/- 0.52 ml/(kg.hr) and the adrenalin dosage 1.36 +/- 0.48 microg/(kg.min), and dopamine 16.35 +/- 3.27 microg/(kg.min) before CVVH. The patients' condition was improved much as demonstrated by pH 7.38 +/- 0.16, BE -0.28 +/- 1.37 mmol/L, MMS 2576 +/- 375 U/L, PO2/FiO2 285 +/- 63, CRT < 2 s, and the adrenalin dosage 0.08 +/- 0.04 microg/(kg.min) and dopamine 8.53 +/- 6.72 microg/(kg.min), urine output 2.9 +/- 1.6 ml/(kg.hr) after 24 hour treatment with CVVH. Of the 9 children, 2 died of MODS (1 intussusception complicated with intestine necrosis, 1 severe scald) and 1 was given up because of severe intestinal fistula, the other 6 children recovered at the end.

CONCLUSIONCBP was effective in treatment of pediatric septic shock by improving the oxygenation, correcting metabolic acidosis, stabilizing BP, increasing the tissue perfusion and eliminating the medium molecule substances.

Acid-Base Equilibrium ; Acute Kidney Injury ; etiology ; physiopathology ; therapy ; Blood Pressure ; Capillaries ; physiopathology ; Child, Preschool ; Female ; Hemofiltration ; methods ; Humans ; Infant ; Male ; Regional Blood Flow ; Respiratory Distress Syndrome, Adult ; etiology ; physiopathology ; therapy ; Severity of Illness Index ; Shock, Septic ; complications ; mortality ; physiopathology ; therapy ; Treatment Outcome