Elsevier

Journal of Critical Care

Volume 15, Issue 3, September 2000, Pages 91-96
Journal of Critical Care

Original Investigations
Acute respiratory distress syndrome: Resource use and outcomes in 1985 and 1995, trends in mortality and comorbidities*

This study was presented, in part, in September 1998 at the Annual Congress of the European Society of Intensive Care Medicine.
https://doi.org/10.1053/jcrc.2000.16461Get rights and content

Abstract

Purpose: The purpose of this study was to compare resource consumption and mortality between (ARDS) patients with adult respiratory distress syndrome treated at our center in 1985 (45 patients) and those treated in 1995. Materials and Methods: This was a retrospective observational study, considering trauma and nontrauma ARDS separately. We recorded severity index scores (APACHE III), infectious complications and multiorgan failure, intensive care unit (ICU) resource consumption (TISS 28), length of stay, time on mechanical ventilation, and ICU mortality. Results: We found no variation in overall ARDS mortality and no reduction in mortality in the ARDS trauma group (43.5% in 1985 vs. 38.5% in 1995, not significant) but a significant increase in mortality among nontrauma septic ARDS patients (68.2% vs. 82.9%, P < .001), largely attributable to the new comorbidities of human immunodeficiency virus (HIV) infection and hematologic malignancy. TISS-28 showed an overall reduction over this time period (49.7 ± 6.6 vs. 38.3 ± 9.7, P < .001), due to fewer monitoring measures, particularly a lower use of pulmonary artery catheter. There were no overall changes in length of stay or days on mechanical ventilation between 1985 and 1995, but these variables did increase among the trauma subgroup. Conclusion: In our setting, mortality remained constant from 1985 to 1995 among ARDS trauma patients but not among nontrauma ARDS patients because of the new case-mix of the latter population, which now includes HIV and other immunodepressed patients. Copyright © 2000 by W.B. Saunders Company

Section snippets

Study population

We retrospectively studied all consecutive patients older than 16 years old that met ARDS criteria11 while admitted to the ICU during 1985 or 1995. We used the Hospital and ICU patient files, which were on paper in 1985 and on computer in 1995. Our hospital is a referral center for medical, surgical, and trauma patients and has a 38-bed adult ICU. The first group initially comprised 58 patients that developed ARDS between January 1 and December 31, 1985; the second group comprised 67 patients

Results

The two groups of ARDS patients from 1985 and 1995 were similar in their admission severity level (APACHE III and APS), age, and sex (Table 1). However, the admission diagnoses varied and there were more immunodepressed patients in 1995, with one hematologic patient in 1985 versus four in 1995, and no AIDS patients in 1985 versus five in 1995.

The proportion of trauma patients was greater in 1985 (45.2% vs. 37.7% in 1995), without reaching statistical significance. The trauma and nontrauma

Discussion

We studied two comparable populations of ARDS patients rated at the same institution but separated by 10 years. Over this period of time, ARDS patients of traumatic origin had different mortality and resource utilization characteristics, in terms of length of stay, days on mechanical ventilation or therapeutic effort (TISS-28 score), when compared with those of nontrauma origin.17, 18

The overall mortality of our series remained constant over time, at 55% and 60% in both time periods studied,

Acknowledgements

The authors wish to thank Dr. Francois Lemaire and Dr. Antonio Artigas for their suggestions and assistance in the data interpretation.

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    *

    Address reprint requests to Pedro Navarrete-Navarro, MD, Critical Care and Emergency Department, Hospital Universitario Virgen de las Nieves, Hospital de Traumatologia, Carretera de Jaen s/n, 18014, Granada, Spain.

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