Bhadade Rakesh, de’Souza Rosemarie, Harde Minal, Asgaonkar Dileep, Tuplondhe Nilesh
J Assoc Physicians India. 2015 Nov;63(11):16-22.
Acute respiratory distress syndrome (ARDS) is a clinical syndrome of severe dyspnoea of rapid onset, hypoxemia, and diffuse pulmonary infiltrates leading to respiratory failure in the absence of cardiac failure. We did the study to asses various aetiologies of ARDS, to determine the correlation between the diagnostic criteria, mortality predictors, need of mechanical ventilation and the outcome of patients. This was an observational, prospective study in medical intensive care unit (MICU) of a tertiary care hospital, over a period of 15 months.
This study encompassed 116 patients of ARDS admitted to an MICU at a tertiary care centre in Mumbai. We included all consecutive patients with ARDS in this study. We excluded patients with known ischemic heart diseases, valvular heart diseases or in congestive cardiac failure, chronic kidney diseases with fluid overload states and age below 18 years.
Males comprised almost 70% (81) of the study population and the presentation was more common in younger age group with total mortality of 57.8% (67 out of 116). Factors attributable for ARDS were malaria in 31 patients (26.72%), pneumonia in 23 (19.82%), sepsis in 20 (17.2%), dengue in 15 (12.96%), undiagnosed fever in 13 (11.1%), leptospirosis in 7 (6.03%), pancreatitis in 3 (2.58%), H1N1 infection in 2 (1.72%), urinary tract infection (UTI) in 1 (0.86%) and UTI with pyelonephritis and Dengue in 1 (0.86 %) patients. Tropical diseases in present study constituted 66 (56.89%) cases of which 31 (47%) died. This difference was statistically found to be significant. Mean PaO2/FiO2 was 178.32 amongst discharged and 127.69 amongst those who expired. Sixty patients had severe LIS, out of which 45 (75%) patients expired, as compared to 56 patients with moderate LIS out of which 22 (39.3%) expired.
Tropical diseases like malaria, dengue, and leptospirosis were the main factors responsible for ARDS. LIS, Modified LIS and PaO2/FiO2 ratio predicted outcome as well as need for mechanical ventilation. Renal failure, metabolic acidosis appeared to be good predictors of mortality.
急性呼吸窘迫综合征（ARDS）是一种临床综合征，起病迅速，表现为严重呼吸困难、低氧血症和弥漫性肺浸润，在无心力衰竭的情况下导致呼吸衰竭。我们开展这项研究以评估ARDS的各种病因，确定诊断标准、死亡率预测因素、机械通气需求与患者预后之间的相关性。这是一项在一家三级医院的医学重症监护病房（MICU）进行的为期15个月的观察性前瞻性研究。
本研究纳入了孟买一家三级医疗中心MICU收治的116例ARDS患者。本研究纳入了所有连续的ARDS患者。我们排除了已知患有缺血性心脏病、瓣膜性心脏病或充血性心力衰竭、伴有液体超负荷状态的慢性肾脏病以及年龄在18岁以下的患者。
男性占研究人群的近70%（81例），发病在较年轻年龄组更为常见，总死亡率为57.8%（116例中的67例）。导致ARDS的因素包括：31例（26.72%）为疟疾，23例（19.82%）为肺炎，20例（17.2%）为脓毒症，15例（12.96%）为登革热，13例（11.1%）为不明原因发热，7例（6.03%）为钩端螺旋体病，3例（2.58%）为胰腺炎，2例（1.72%）为H1N1感染，1例（0.86%）为尿路感染（UTI），1例（0.86%）为UTI合并肾盂肾炎和登革热。本研究中的热带疾病构成66例（56.89%），其中31例（47%）死亡。经统计学分析，这一差异具有显著性。出院患者的平均PaO2/FiO2为178.32，死亡患者为127.69。60例患者的肺损伤评分（LIS）为重度，其中45例（75%）死亡；56例患者的LIS为中度，其中22例（39.3%）死亡。
疟疾、登革热和钩端螺旋体病等热带疾病是导致ARDS的主要因素。LIS、改良LIS和PaO2/FiO2比值可预测预后以及机械通气需求。肾衰竭、代谢性酸中毒似乎是死亡率的良好预测因素。
