Objectives: Several studies have been published in western literature on incidence, prevalence, clinical course, outcome and mortality in patients with acute respiratory distress syndrome (ARDS). There are very few studies on the pattern of ARDS seen in Indian population. There are anecdotal reports of ARDS associated with different tropical diseases and the exact association of these life-threatening disorders with ARDS is not clearly described in the Indian literature. The study was carried out to identify the clinical pattern of Indian patients who died of ARDS.
Methods: This was a three and a half year retrospective study comprising of 98 patients who died of ARDS in the intensive care unit of Apollo Hospital, a tertiary care referral centre between January 1999 to June 2002. The present study looked at only those patients who died from ARDS and did not evaluate the clinical outcome or survival pattern of ARDS patients. The criteria used for diagnosis of ARDS was based upon American/European consensus statement for definition of acute lung injury (ALI) and ARDS. The patient demographic data consisted of age, sex, associated major illness in the part, clinical disorders associated with ARDS, length of hospital stay, use and duration of mechanical ventilation and the presence of sepsis and organ failure defined by ACCP/SCCM consensus conference definition. Seventy patients were ventilated with volume control mode and 28 patients with pressure control ventilation. Lung protective strategy was used in all the cases comprising of low tidal volumes at the rate of 5-ml/kg-body weight. Statistical analysis of the data was done by SPSS 10 for windows (SPSS, Inc., Chicago, Illinois).
Results: There were 98 patients during the study period who died of ARDS. Fifty one males and 47 female patients. Thirty patients had primary pulmonary infection, 18 had severe sepsis with multiorgan failure, 12 patients had polytrauma and 10 each had recent abdominal surgery and pancreatitis. Length of ICU stay was less than 10 days in 58 patients whereas in 40 patients it was more than 10 days. Duration of mechanical ventilation was less than seven days in 80 patients and more than seven days in 18 patients. Positive body fluid cultures were obtained in 42 out of 98 patients and of these, 14 patients had microbiological diagnosis established by blood culture, another 14 by endotracheal secretion culture, eight by urine culture and in the remaining six patients based upon wound cultures. The commonest organisms isolated from the body fluids were Pseudomonas and Klebsiella.
Conclusion: Primary pulmonary infection was associated with ARDS is one-third of patients. Multiorgan failure was seen in 18% of patients who died from ARDS. Severe sepsis was identified as a significant risk factor for ARDS.