Abstract
To identify outcome improvement factors in ARDS patients managed with lung protective ventilation and defined according to the Berlin diagnostic criteria.
A retrospective observational study was conducted in a total of 41 ARDS patients who were diagnosed according to the Berlin ARDS criteria. Demographic, clinical, laboratory, and radiological criteria were assessed for all patients, and sputum, blood, and urine samples were obtained on the first day of hospitalization and on the day of ventilator-associated pneumonia diagnosis. In addition, fluid balance was assessed by the end of the first week of ventilation. Significant factors associated with survival improvement and predictors of mortality were identified using the bivariate analysis. ROC curves were created to evaluate the accuracy of some of the factors affecting survival.
In this study 25 variables were significantly correlated with mortality. The non-surviving patients had tachypnea and tachycardia; lower diastolic blood pressure, PaO2/FiO2, PO2, O2sat, and HCO3 values; and higher FiO2 and PCO2 values. Additionally, they had lower serum Na and higher K, pH, and creatinine levels. The level of CRP and GCS score were significantly lower in the non-surviving patients. However, the average fluid balance in the non-surviving patients was positive. Additionally, 4 non-surviving patients (33.3%) developed hospital-acquired pneumonia. A good general condition, indicated by a GCS score was the most accurate improvement prediction factor, then proper oxygenation. In contrast, a delay in ICU admission, increase in serum creatinine level, and a positive fluid balance were accurate predictive factors of mortality.
Early diagnosis and ICU admission, a PaO2/FiO2 ratio maintained above 90, a GCS score above 9, a negative fluid balance, a serum creatinine level less than 1.5mg/dl, and the prevention of HAP were factors associated with an improved outcome in ARDS.