Taborda Lúcia, Barros Filipa, Fonseca Vitor, Irimia Manuel, Carvalho Ramiro, Diogo Cláudia, Ramos Armindo
Serviço de Medicina Interna. Hospital Nossa Senhora do Rosário. Centro Hospitalar Barreiro-Montijo. Barreiro. Portugal..
Unidade de Cuidados Intensivos. Hospital de Cascais Dr José de Almeida. Cascais. Portugal.
Acta Med Port. 2014 Mar-Apr;27(2):211-7. Epub 2014 Apr 30.
Acute Respiratory Distress Syndrome has a significant incidence and mortality at Intensive Care Units. Therefore, more studies are necessary in order to develop new effective therapeutic strategies. The authors have proposed themselves to characterize Acute Respiratory Distress Syndrome patients admitted to an Intensive Care Unit for 2 years.
This was an observational retrospective study of the patients filling the Acute Respiratory Distress Syndrome criteria from the American-European Consensus Conference on ARDS, being excluded those non invasively ventilated. Demographic data, Acute Respiratory Distress Syndrome etiology, comorbidities, Gravity Indices, PaO2/FiO2, ventilator modalities and programmation, pulmonary compliance, days of invasive mechanical ventilation, corticosteroids use, rescue therapies, complications, days at Intensive Care Unit and obits were searched for and were submitted to statistic description and analysis.
A 40 patients sample was obtained, with a median age of 72.5 years (interquartile range = 22) and a female:male ratio of ≈1:1.86. Fifty five percent of the Acute Respiratory Distress Syndrome cases had pulmonary etiology. The mean minimal PaO2/FiO2 was 88 mmHg (CI 95%: 78.5-97.6). The mean maximal applied PEEP was 12.4 cmH2O (Standard Deviation 4.12) and the mean maximal used tidal volume was 8.2 mL/ Kg ideal body weight (CI 95%: 7.7-8.6). The median invasive mechanical ventilation days was 10. Forty seven and one half percent of the patients had been administered corticosteroids and 52.5% had been submitted to recruitment maneuvers. The most frequent complication was Ventilator Associated Pneumonia (20%). The median Intensive Care Unit stay was 10.7 days (interquartile range 10.85). The fatality rate was 60%. The probability of the favorable outcome 'non-death in Intensive Care Unit' was 4.4x superior for patients who were administered corticosteroids and 11x superior for patients < 65 years old.
Acute Respiratory Distress Syndrome is associated with long hospitalization and significant mortality. New prospective studies will be necessary to endorse the potential benefit of steroid therapy and to identify the subgroups of patients that warrant its use.
急性呼吸窘迫综合征在重症监护病房的发病率和死亡率都很高。因此，需要开展更多研究以制定新的有效治疗策略。作者对入住重症监护病房达两年的急性呼吸窘迫综合征患者进行了特征描述。
这是一项观察性回顾性研究，研究对象为符合美国-欧洲急性呼吸窘迫综合征共识会议急性呼吸窘迫综合征标准的患者，无创通气患者被排除在外。收集人口统计学数据、急性呼吸窘迫综合征病因、合并症、病情严重程度指数、动脉血氧分压/吸入氧分数值、通气模式及设置、肺顺应性、有创机械通气天数、皮质类固醇使用情况、挽救治疗、并发症、在重症监护病房的天数及死亡情况，并进行统计学描述与分析。
共纳入40例患者，中位年龄为72.5岁（四分位间距 = 22），男女比例约为1:1.86。55%的急性呼吸窘迫综合征病例病因是肺部疾病。平均最低动脉血氧分压/吸入氧分数值为88 mmHg（95%置信区间：78.5 - 97.6）。平均最大呼气末正压为12.4 cmH₂O（标准差4.12），平均最大潮气量为8.2 mL/理想体重千克（95%置信区间：7.7 - 8.6）。有创机械通气天数的中位数为10天。47.5%的患者使用了皮质类固醇，52.5%的患者接受了肺复张手法治疗。最常见的并发症是呼吸机相关性肺炎（20%）。在重症监护病房的住院天数中位数为10.7天（四分位间距10.85）。死亡率为60%。接受皮质类固醇治疗的患者“在重症监护病房未死亡”这一良好结局的概率高出4.4倍，65岁以下患者高出11倍。
急性呼吸窘迫综合征与住院时间长及高死亡率相关。需要开展新的前瞻性研究来证实类固醇治疗的潜在益处，并确定适合使用该治疗的患者亚组。
