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Intensive Care Medicine

, Volume 26, Issue 5, pp 508–517 | Cite as

The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation

  • O. R. Luhr
  • M. Karlsson
  • A. Thorsteinsson
  • C. Rylander
  • C. G. Frostell
ORIGINAL

Abstract

Objectives: Primarily, to determine if respiratory variables, assessed on a daily basis on days 1–6 after ICU admission, were associated with mortality in non-ARDS and ARDS patients with respiratory failure requiring mechanical ventilation. Secondarily, to determine non-respiratory factors associated with mortality in ARDS and non-ARDS patients. Design: Prospective multicentre clinical study. Setting: Seventy-eight intensive care units in Sweden and Iceland. Patients: Five hundred twenty non-ARDS and 95 ARDS patients. Measurements and results: Potentially prognostic factors present at inclusion were tested against 90-day mortality using a Cox regression model. Respiratory variables (PaO2/FIO2, PEEP, mean airway pressure (MAP) and base excess (BE)) were tested against mortality using the model. Primary aim: in non-ARDS a low PaO2/FIO2 on day 1, RR (risk ratio) = 1.17, CI (95 % confidence interval) (1.00; 1.36), day 4, 1.24 (1.02; 1.50), day 5, 1.25 (1.02; 1.53) and a low MAP at baseline, 1.18 (1.00; 1.39), day 2, 1.24 (1.02; 1.52), day 3, 1.33 (1.06; 1.67), day 6, 2.38 (1.11; 5.73) were significantly associated with 90-day death. Secondary aim: in non-ARDS a low age, RR = 0.77 (0.67; 0.89), female gender, 0.85 (0.74; 0.98), and low APS (acute physiologic score), 0.85 (0.73; 0.99), were associated with survival; chronic disease, 1.31 (1.12; 1.52), and non-pulmonary origin to the respiratory failure, 1.27 (1.10; 1.47), with death. In ARDS low age, RR = 0.65 CI (0.46; 0.91), and low APS, 0.65 (0.46; 0.90), were associated with survival. Conclusions: No independent significant association was seen between 90-day mortality and degree of hypoxaemia, PEEP, MAP or BE for the first full week of ICU care in either ARDS or non-ARDS. In a sub-group of non-ARDS a lower PaO2/FIO2 and MAP tended to influence mortality where a significant association was seen for 3 of 7 study days. Age, gender, APS, presence of a chronic disease and a pulmonary/non-pulmonary reason for the respiratory failure were associated with mortality in non-ARDS, while only age and APS showed a similar association in ARDS.

Key words Acute respiratory distress syndrome Acute lung injury Mortality Risk factors Multivariate analysis Prospective studies Respiratory insufficiency Positive-pressure respiration 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • O. R. Luhr
    • 1
  • M. Karlsson
    • 2
  • A. Thorsteinsson
    • 3
  • C. Rylander
    • 4
  • C. G. Frostell
    • 5
  1. 1.Division of Anaesthesia and Intensive Care, Karolinska Institute at Danderyd Hospital, S-182 88 Danderyd, Sweden e-mail: Owe.Luhr@ane.ds.sll.se Tel.: + 46-8-6 55 52 81 Fax: + 46-8-6 22 59 26SE
  2. 2.Division of Anaesthesia and Intensive Care, Karolinska Hospital, Stockholm, SwedenSE
  3. 3.Division of Anaesthesia and Intensive Care, Landspitalinn University Hospital, Reykjavik, IcelandIS
  4. 4.Division of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, SwedenSE
  5. 5.Department of Paediatric Intensive Care, Astrid Lindgren Children's Hospital, Karolinska Hospital, Stockholm, SwedenSE

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