1887
Volume 2019, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Although acute respiratory distress syndrome (ARDS) is a common reason for admission to intensive care units, limited information is available about the epidemiological and clinical characteristics of these patients in Middle Eastern countries. Qatar is a high per capita income country with a large multinational expatriate population. Hamad General Hospital is our main tertiary referral center with the largest medical intensive care unit (MICU). A retrospective cross-sectional study was conducted to extract data from the MICU registry for 101 patients aged >14 years who were admitted with ARDS from January 2015 to December 2015. In 2015, a total of 101 (14.8%) of 682 patients admitted to MICU were diagnosed with ARDS. Males comprised 71.3% and females 28.7%. The mean age of the study population was 44.96 ± 17.97 years. Community-acquired bacterial and viral pneumonia were the most common reasons for ARDS. Crude mortality rate was 35%. The mean age of survivors was 42.09 ± 13.58 years compared with 50.36 ± 16.84 years of non-survivors (0.008). Mortality was associated with increasing age, the Acute Physiologic Assessment and Chronic Health Evaluation II severity score, lower P/F ratio, higher Murray's score, higher PCO, lower pH, and circulatory support with vasopressors. Preexisting comorbidities did not contribute to high mortality. No difference in mortality was noted with higher versus lower positive end expiratory pressure. The prone position was used in 8% of the cases. Twenty-seven (27%) patients had undergone salvage therapy with extracorporeal membrane oxygenation (ECMO) that resulted in a survival rate of 44%. ARDS was associated with acute renal failure requiring dialysis in 28.7% of the cases, pneumothoraces in 4%, ventilator-associated pneumonia in 7.9%, and central line-associated bloodstream infection in 2%. ARDS led to a prolonged length of stay compared with the average length of stay in MICU. Community-acquired bacterial and viral pneumonia were the most common causes of ARDS at our center. Critical care outcome correlated with the severity of the disease. ECMO was used as salvage therapy in our center.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2019.3
2019-07-30
2019-08-19
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2019/1/qmj.2019.3.html?itemId=/content/journals/10.5339/qmj.2019.3&mimeType=html&fmt=ahah

References

  1. Bellani   G., , Laffey   JG., , Pham   T., , Fan   E., , Brochard   L., , Esteban   A. , et al.   Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. . JAMA . 2016 Feb 23; ;315: 8 : 788– 800 . doi:10.1001/jama.2016.0291 .
    [Google Scholar]
  2. ARDS Definition Task Force., , Ranieri   VM., , Rubenfeld   GD., , Thompson   BT., , Ferguson   ND., , Caldwell   E. , et al.   Acute respiratory distress syndrome: the Berlin definition. . JAMA . 2012 Jun 20; ;307: 23 : 2526– 2533 . doi:10.1001/jama.2012.5669 .
    [Google Scholar]
  3. Summers   C., , Singh   NR., , Worpole   L., , Simmonds   R., , Babar   J., , Condliffe   AM. , et al.   Incidence and recognition of acute respiratory distress syndrome in a UK intensive care unit. . Thorax . 2016 Nov; ;71: 11 : 1050– 1051 . doi:10.1136/thoraxjnl-2016-208402 .
    [Google Scholar]
  4. Riviello   ED., , Kiviri   W., , Twagirumugabe   T., , Mueller   A., , Banner-Goodspeed   VM., , Officer   L. , et al.   Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. . Am J Respir Crit Care Med . 2016 Jan 1; ;193: 1 : 52– 59 . doi:10.1164/rccm.201503-0584OC .
    [Google Scholar]
  5. Luo   J., , Yu   H., , Hu   YH., , Liu   D., , Wang   YW., , Wang   MY. , et al.   Early identification of patients at risk for acute respiratory distress syndrome among severe pneumonia: a retrospective cohort study. . J Thorac Dis . 2017 Oct; ;9: 10 : 3979– 3995 . doi:10.21037/jtd.2017.09.20 .
    [Google Scholar]
  6. Bhadade   RR., , de Souza   RA., , Harde   MJ., , Khot   A. . Clinical characteristics and outcomes of patients with acute lung injury and ARDS. . J Postgrad Med . 2011 Oct-Dec; ;57: 4 : 286– 290 . doi:10.4103/0022-3859.90077 .
    [Google Scholar]
  7. Ministry of Development Planning and Statistics [Internet] . 2016; ; . Analysis of the results of population, housing and establishments census 2015. Doha–Qatar. Available from: https://www.mdps.gov.qa/en/statistics/Statistical%20Releases/General/Census/Outcome_Analysis_of_Census_of_Population_Housing_and_Establishments_2015_en.pdf .
  8. Kao   KC., , Hsieh   MJ., , Lin   SW., , Chuang   LP., , Chang   CH., , Hu   HC. , et al.   Survival predictors in elderly patients with acute respiratory distress syndrome: a prospective observational cohort study. . Sci Rep . 2018 Sep 7; ;8: 1 : 13459 . doi:10.1038/s41598-018-31811-w .
    [Google Scholar]
  9. Chen   W., , Ware   LB. . Prognostic factors in the acute respiratory distress syndrome. . Clin Transl Med . 2015 Dec; ;4: 1 : 65 . doi:10.1186/s40169-015-0065-2 .
    [Google Scholar]
  10. Forel   JM., , Voillet   F., , Pulina   D., , Gacouin   A., , Perrin   G., , Barrau   K. , et al.   Ventilator-associated pneumonia and ICU mortality in severe ARDS patients ventilated according to a lung-protective strategy. . Crit Care . 2012 Dec 12; ;16: 2 : R65 . doi:10.1186/cc11312 .
    [Google Scholar]
  11. Santamaria   JD., , Tobin   AE., , Reid   DA. . Do we practise low tidal-volume ventilation in the intensive care unit? a 14-year audit. . Crit Care Resusc . 2015 Jun; ;17: 2 : 108– 112 .
    [Google Scholar]
  12. Guérin   C., , Beuret   P., , Constantin   JM., , Bellani   G., , Garcia-Olivares   P., , Roca   O. , et al.   A prospective international observational prevalence study on prone positioning of ARDS patients: the APRONET (ARDS Prone Position Network) study. . Intensive Care Med . 2018 Jan; ;44: 1 : 22– 37 . doi:10.1007/s00134-017-4996-5 .
    [Google Scholar]
  13. Jahangirifard   A., , Hossein Ahmadi   Z., , Golestani Eraghi   M., , Tabarsi   P., , Marjani   M., , Moniri   A. , et al.   H1N1 influenza patient saved by extracorporeal membrane oxygenation: first report from Iran. . J Tehran Heart Cent . 2016 Jul 6; ;11: 3 : 153– 156 .
    [Google Scholar]
  14. Andresen   M., , Tapia   P., , Mercado   M., , Bugedo   G., , Bravo   S., , Regueira   T. . Catastrophic respiratory failure from tuberculosis pneumonia: survival after prolonged extracorporeal membrane oxygenation support. . Respir Med Case Rep . 2013 Jul 24; ;10: : 19– 22 . doi:10.1016/j.rmcr.2013.06.004 .
    [Google Scholar]
  15. Cogliandro   V., , Lapadula   G., , Bandera   A., , Muscatello   A., , Marcolin   R., , Abbruzzese   C. , et al.   ECMO: an alternative support for acute respiratory failure caused by tuberculosis?.   Int J Tuberc Lung Dis . 2014 Jul; ;18: 7 : 879– 881 . doi:10.5588/ijtld.13.0752 .
    [Google Scholar]
  16. Bedeir   K., , Seethala   R., , Kelly   E. . Extracorporeal life support in trauma: worth the risks? A systematic review of published series. . J Trauma Acute Care Surg . 2017 Feb; ;82: 2 : 400– 406 . doi:10.1097/TA.0000000000001292 .
    [Google Scholar]
  17. Makdisi   G., , Wang   I. . Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. . J Thorac Dis . 2015 Jul; ;7: 7 : E166– E176 . doi:10.3978/j.issn.2072-1439.2015.07.17 .
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2019.3
Loading
/content/journals/10.5339/qmj.2019.3
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): acute respiratory distress syndrome , extracorporeal membrane oxygenation and pneumonia
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error