Clinical spectrum of acute respiratory distress syndrome in a tertiary referral hospital: Etiology, severity, clinical course, and hospital outcome

Background and purpose: The clinical picture of patients with acute respira tory distress syndrome (ARDS) in Taiwan has seldom been reported, although new definitions of ARDS have been introduced over the past years. The purpo se of this study was to investigate the clinical characteristics, modalitie s of management, and outcomes in patients with ARDS treated in a tertiary r eferral hospital. Methods: Case records were selected through a computerized search of diagno sis codified at discharge during the period from January 1995 to June 1997. Patients who met the criteria of the American-European Consensus Conferenc e definition of ARDS were included and their medical records were retrospec tively reviewed. Results: A total of 145 patients (91 men, 54 women; mean age, 58 years) who fulfilled the criteria for ARDS were identified. Malignancy (n = 53) and d iabetes mellitus (n = 23) were the most common co-morbid conditions. Pneumo nia (n = 90), including community-acquired pneumonia in 45 (31%) patients, was the most common risk factor. The lung injury score at the time of ARDS diagnosis was 2.89 +/- 0.40 (mean +/- standard error, SE). The worst value of PaO2P/FIO2 was 86.8 +/- 3.8 mm Hg (mean +/- SE). Among the 145 patients, 130 (90%) received mechanical ventilation and 118 (81%) were treated in th e intensive care unit. In-hospital mortality was 81%. Seventy (48%) patient s received intensive treatment for ARDS, among whom 52 (74%) died; the most common causes of death were multiple organ failure (54%) and respiratory f ailure (23%). Conclusions: The mortality in patients with ARDS was high in this tertiary referral institution. Our findings suggest that aggressive ventilatory, pha rmacologic, and supportive therapy may be important to achieve a higher sur vival rate.