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2015, Number 2

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Rev Cub Med Int Emerg 2015; 14 (2)

Mortality presage factors of the acute respiratory distress syndrome

Núñez BA, Ramos FO

Language: Spanish
References: 29
Page: 49-61
PDF size: 229.21 Kb.


ABSTRACT

Introduction: The lung lesion is able to discharge because of direct damage (pneumonia, aspiration) as an indirect one (sepsis, pancreatitis) on the lung parenchyma, and cause alterations of the endothelial barrier and changes in the alveolar epithelium.
Objective: To analyze the frequency of the acute respiratory distress syndrome (ARDS) and the presage factors of mortality in these patients.
Method: Descriptive and prospective study, of traverse court, of the all patients discharges of the intensive care unit ICU3, at "Abel Santamaria Cuadrado" Educational and General Hospital, with the diagnosis of acute respiratory distress syndrome. The main variable was the mortality to the 30 days. The square Chi test was used for qualitative variables and the t Student test for quantitative variables.
Results: Forty eight (5.8%) of the total entrance in UCI3 completed the approaches of ARDS. The origin of the ARDS was pulmonary insult in the 58.3% and secondary to septic causes (pulmonary or nonpulmonary) in the rest of the patients. A 65% of the patients presented multiple-system organ failure and a 54.2% a breathing new over infection. The medium of the stay in ICU was of 17 days. The mortality in the 30 days was 48.9%. The average value of PEEP used in the first day was 10 cmH2O.
Conclusions: The ARDS is an elevating mortality entity, which presage associates not only to the graveness of the deterioration of the lung function, but to the systemic as well.


REFERENCES

  1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2:319-23.

  2. Brun BC, Minelli C, Bertolini G, Brazzi L, Pimentel J , Lewandowski K, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Intensive care medicine. 2004;30(1):51-61.

  3. Brower RG, Morris A, MacIntyre N, Matthay MA, Hayden D, Thompson T,et al. ARDS Clinical Trials Network, National Heart, Lung, and Blood Institute, National Institutes of Health: Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med. 2003;31(11):2592-7.

  4. Sánchez PA. Factores pronóstico en el distrés respiratorio agudo. Rev Cub Med Int Emerg. 2003;2:46-54.

  5. Lamas A. Distrés Respiratorio Agudo. Primer Premio Concurso Nacional del MINSAP. Santiago de Cuba; 1996:1-50.

  6. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS: Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994; 149: 818-24.

  7. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M. Incidence and outcome of acute lung injury. N Engl J Med. 2006;353(16):1685-93.

  8. Esteban A, Anzuelo A, Frutos F, Alia I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2007;287(3):345-55.

  9. Rocco PR, Pelosi P. Pulmonary and extrapulmonary acute respiratory distress syndrome: myth or reality? Curr Opin Crit Care. 2008;14(1):50–6.

  10. Amato MBP, Barbas CSV, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. New England Journal of Medicine. 1998;338(6):347- 354.

  11. Estenssoro E, Dubin A, Laffaire E, Canales H, Sáenz G, Moseinco M, et al. Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Critical care medicine. 2002;30(11):2450.

  12. Esteban A, Fernández SP, Frutos VF, Aramburu JA, Nájera L. Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings. Am Intern Med. 2007;141(6):440.

  13. Fernández FR. Fisiopatología del intercambio gaseoso en el SDRA. Med Intensiva. 2006;30(8):374-8.

  14. Arnaud W. Thille, Christophe J, Richard M, Maggiore S, Ranieri VM, Brochard M. Alveolar Recruitment in Pulmonary and Extrapulmonary Acute Respiratory Distress Synd Anesthesiology. 2007;106(2):213-17.

  15. Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354(17):1775–86.

  16. Leone M, Garcin F, Bouvenot J, Boyadjev I,Visintini P. Ventilator-associated pneumonia: Breaking the vicious circle of antibiotic over use. Crit Care Med. 2007;35(2):379–85.

  17. Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusión- related acute lung injury. Transfusión. 1985;25(6):573-7.

  18. Villar J, Pérez-Méndez L, López J, Belda J, Blanco J, Saralegui I. An early PEEP/FIO2 trial identifies different degrees of lung injury in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2007;176(8):795– 804.

  19. Martínez O, Nin N, Esteban A. Evidencias de la posición en decúbito prono para el tratamiento del síndrome de distrés respiratorio agudo: una puesta al día. Arch Bronconeumol. 2009;45:291-6.

  20. Phoenix SI, Paravastu S, Columb M, Vincent JL, Nirmalan M. Does a higher positive end expiratory pressure decrease mortality in acute respiratory distress syndrome? A systematic review and meta-analysis. Anesthesiology. 2009;110(5):1098–105.

  21. The Acute Respiratory Distress Syndrome Network. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;351:327-36.

  22. Rialp Cervera G. Efectos del decúbito prono en el síndrome de distrés respiratorio agudo (SDRA). Med Intensiva. 2006;27(7):481-7

  23. Sud S, Friedrich JO, Taccone P, Polli F, Adhikari NK, Latini R. Prone ventilation reduces mortality in patients with acute respiratory failure and severe hypoxemia: systematic review and meta-analysis. Intensive Care Med. 2010;36(4):585-99.

  24. Roupie E, Lepage E, Wysocki M, Fagon JY, Chastre J, Dreyfuss D, et al. Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. Intensive Care Med. 1999;25(9):920-9.

  25. Ferguson ND, Frutos VF, Esteban A, Anzueto A, Alía I, Brower RG. Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome. Crit Care Med. 2006;33(1):21-30.

  26. Martínez O, Nin N, Esteban A. Evidencias de la posición en decúbito prono para el tratamiento del síndrome de distrés respiratorio agudo: una puesta al día. Arch Bronconeumol. 2009;5:291-6.

  27. Gordo VF, Gómez TV, Palencia HE, Latour PJ, Sánchez AB, Díaz AR. PEEP alta frente a PEEP convencional en el síndrome de distrés respiratorio agudo Revisión sistemática y metaanálisis. Med Intensiva. 2007;31(9):491-501.

  28. Rocco PR, Pelosi P. Pulmonary and extrapulmonary acute respiratory distress syndrome: myth or reality? Curr Opin Crit Care. 2008;14(1):50-5.

  29. Álvarez-Lerma F, Palomar F, Olaechea P, Otal JJ, Insausti J, Grupo de Estudio de Vigilancia de Infección Nosocomial en UCI. Estudio Nacional de Vigilancia de Infección Nosocomial en UCI. Informe de los años 2003–2005. Med Intensiva. 2007;31:6–17.




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