Background
Methods
Inclusion of patients
Data collection and definition of severity
Pathologic criteria for DAD
Statistical analysis
Results
ARDS without DAD (n = 197) | ARDS with DAD (n = 159) |
p Value | |
---|---|---|---|
Characteristics of the patients | |||
Age, years | 66.4 ± 14.0 | 64.3 ± 14.7 | 0.17 |
Female sex, n (%) | 58 (29.4%) | 68 (42.8%) | 0.01 |
SAPS II, points | 55.5 ± 19.6 | 50.9 ± 16.1 | 0.02 |
Duration of MV before death, days | 12.7 ± 21.7 | 13.1 ± 11.0 | 0.82 |
Duration of ARDS evolution ≥ 72 h, n (%) | 101 (51%) | 128 (81%) | <0.01 |
Risk factor triggering ARDS | |||
Pneumonia, n (%) | 62 (31.5%) | 66 (41.5%) | 0.04 |
Other pulmonary risk factors of ARDS, n (%) | 12 (6.1%) | 7 (4.4%) | 0.48 |
Shock, n (%) | 118 (59.9%) | 83 (52.2%) | 0.14 |
Extrapulmonary sepsis, n (%) | 73 (37.1%) | 56 (35.2%) | 0.72 |
Pancreatitis, n (%) | 12 (6.1%) | 7 (4.4%) | 0.48 |
Blood gases | |||
PaO2, mmHg | 93 ± 37 | 79 ± 27 | <0.01 |
PaO2/FiO2, mmHg | 140 ± 67 | 104 ± 53 | <0.01 |
PaCO2, mmHg | 44.5 ± 12.8 | 49.1 ± 15.0 | <0.01 |
Severity of hypoxemia | <0.01 | ||
200 < PaO2/FiO2 ≤ 300 mmHg, n (%) | 43 (22%) | 6 (4%) | |
100 < PaO2/FiO2 ≤ 200 mmHg, n (%) | 85 (43%) | 56 (35%) | |
PaO2/FiO2 ≤ 100 mmHg, n (%) | 69 (35%) | 97 (61%) | |
Ventilatory settings | |||
Tidal volume, ml | 620 ± 133 | 623 ± 157 | 0.87 |
Respiratory rate, cycles/minute | 20 ± 6 | 22 ± 7 | <0.01 |
Minute ventilation, L/minute | 11.9 ± 3.2 | 13.1 ± 3.4 | <0.01 |
FiO2
| 0.75 ± 0.25 | 0.85 ± 0.22 | <0.01 |
PEEP, cmH2O | 7.9 ± 4.5 | 9.6 ± 4.1 | <0.01 |
PEEP ≥ 10 cmH2O, n (%) | 91 (46%) | 106 (67%) | <0.01 |
Physiological parameters | |||
Peak pressure, cmH2O | 37 ± 10 | 44 ± 10 | <0.01 |
Dynamic driving pressure (peak − PEEP), cmH2O | 28 ± 11 | 34 ± 9 | <0.01 |
Dynamic compliance, ml/cmH2O | 24 ± 11 | 20 ± 7 | <0.01 |
Dynamic compliance < 40 ml/cmH2O, n (%) | 174 (88%) | 155 (97%) | <0.01 |
VE corrected PaCO2, L/minute | 13 ± 5 | 16 ± 7 | <0.01 |
VE corrected PaCO2 ≥ 10 L/minute, n (%) | 135 (69%) | 133 (84%) | <0.01 |
Extent of infiltrates on chest radiograph | <0.01 | ||
Two quadrants, n (%) | 64 (32%) | 17 (11%) | |
Three quadrants, n (%) | 63 (32%) | 41 (26%) | |
Four quadrants, n (%) | 70 (36%) | 101 (63%) | |
Lung weight at autopsy examination, g | 1567 ± 709 | 1848 ± 748 | <0.01 |
Bivariate test, OR (95% CI), p value | Multivariate logistic regression, OR (95% CI), p value | |
---|---|---|
Characteristics of the patients | ||
Female sex, n (%) | 1.79 (1.15–2.78), p < 0.01 | Not significant |
Pneumonia, n (%) | 1.54 (0.99–2.39), p = 0.05 | Not significant |
Duration of evolution of ARDS | ||
> 72 h | 3.92 (2.43–6.37), p < 0.001 |
3.29 (1.95–5.55),
p
< 0.001
|
Severity of hypoxemia | <0.0001 | |
Mild ARDS (n = 49) | Reference | |
Moderate ARDS (n = 141) | 4.72 (1.88–11.8), p < 0.001 |
3.92 (1.48–10.3),
p
= 0.006
|
Severe ARDS (n = 166) | 10.1 (4.06–24.9), p < 0.001 |
6.18 (2.34–16.3),
p
< 0.001
|
Ancillary variables of severity | ||
PEEP ≥ 10 cmH2O | 2.33 (1.51–3.59), p < 0.001 | Not significant |
Dynamic compliance < 40 ml/cmH2O | 5.12 (1.73–15.1), p < 0.01 | Not significant |
VE corrected PaCO2 ≥ 10 L/minute | 2.34 (1.40–3.93), p < 0.01 | Not significant |
PaCO2 > 45 mmHg | 1.73 (1.14–2.65), p = 0.01 | Not significant |
Dynamic driving pressure (peak − PEEP), cmH2O | 1.06 (1.04–1.09), p < 0.001 |
1.06 (1.04–1.09),
p
= 0.007
|
Extent of infiltrates on chest radiograph | <0.0001 | |
Two quadrants | Reference | |
Three quadrants | 2.45 (1.26–4.76), p < 0.01 | 1.63 (0.79–3.39), p = 0.19 |
Four quadrants | 5.43 (2.93–10.1), p < 0.0001 |
2.91 (1.47–5.75),
p
= 0.002
|