Clinical And Radiological Profile of Acute Respiratory Distress Syndrome and Its Association With In-Hospital Mortality: An Observational Study From A Tertiary Care Intensive Care Unit in North India

Abstract

Objective: To describe the clinical, radiological, microbiological and physiological profile of acute respiratory distress syndrome in a tertiary intensive care unit and identify features associated with in-hospital mortality.

Methods: Observational study of 50 consecutive patients meeting American–European Consensus Conference criteria between February and July 2014. Clinical findings, arterial blood gases, laboratory parameters, chest radiography, computed tomography, cultures and Sequential Organ Failure Assessment scores on days 1 and 3 were recorded. Those who died were compared with survivors using the Student t test and chi-square test, with Fisher's exact test where expected counts were small.

Results: Thirty-three patients (66.0%) died. Mean age was 44.9 ± 17.3 years; 64.0% were aged 50 or younger. Mortality was higher in women (82.6%) than in men (51.9%; p = 0.022). Sepsis and pulmonary infection caused 90% of cases; direct and indirect injury contributed equally. Pallor (p = 0.008), inotrope requirement (p = 0.007), higher heart rate (p = 0.044) and positive end-expiratory pressure (p = 0.002), lower oxygen tension (p = 0.002) and ratio of oxygen tension to inspired oxygen fraction (p < 0.001), and lower haematocrit (p = 0.028) were associated with death. Diffuse consolidation on computed tomography predicted death and tracked direct injury (p < 0.001). Baseline organ dysfunction scores did not differ, but a rising score over three days did (p = 0.012). Age, comorbidity, smoking and culture results did not.

Conclusion: Mortality was high in a young population. The trajectory of organ dysfunction discriminated better than any single admission measurement.