Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/333
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Type: Journal article
Title: Modelling thirty-day mortality in the acute respiratory distress syndrome (ARDS) in an adult ICU
Author: Moran, J.
Solomon, P.
Fox, V.
Salagaras, M.
Williams, P.
Quinlan, K.
Bersten, A.
Citation: Anaesthesia and Intensive Care, 2004; 32(3):317-329
Publisher: Australian Soc Anaesthetists
Issue Date: 2004
ISSN: 0310-057X
1448-0271
Statement of
Responsibility: 
J. L. Moran, P. J. Solomon, V. Fox, M. Salagaras, P. J. Williams, K. Quinlan, A. D. Bersten
Abstract: Variables predicting thirty-day outcome from Acute Respiratory Distress Syndrome (ARDS) were analysed using Cox regression structured for time-varying covariates. Over a three-year period, 1996-1998, consecutive patients with ARDS (bilateral chest X-ray opacities, PaO₂/FiO₂ ratio of <200 and an acute precipitating event) were identified using a prospective computerized data base in a university teaching hospital ICU. The cohort, 106 mechanically ventilated patients, was of mean (SD) age 63.5 (15.5) years and 37% were female. Primary lung injury occurred in 45% and 24% were postoperative. ICU-admission day APACHE II score was 25 (8); ARDS onset time from ICU admission was 1 day (median: range 0-16) and 30 day mortality was 41% (95% CI: 33%-51%). At ARDS onset, PaO₂/FiO₂ ratio was 92 (31), 81% had four-quadrant chest X-ray opacification and lung injury score was 2.75 (0.45). Average mechanical ventilator tidal volume was 10.3 ml/ predicted kg weight. Cox model mortality predictors (hazard ratio, 95% CI) were: APACHE II score, 1.15 (1.09-1.21); ARDS lag time (days), 0.72 (0.58-0.89); direct versus indirect injury, 2.89 (1.45-5.76); PaO₂/FiO₂ ratio, 0.98 (0.97-0.99); operative versus non-operative category, 0.24 (0.09-0.63). Time-varying effects were evident for PaO₂/FiO₂ ratio, operative versus non-operative category and ventilator tidal volume assessed as a categorical predictor with a cut-point of 8 ml/kg predicted weight (mean tidal volumes, 7.1 (1.9) vs 10.7 (1.6) ml/kg predicted weight). Thirty-day survival was improved for patients ventilated with lower tidal volumes. Survival predictors in ARDS were multifactorial and related to patient-injury-time interaction and level of mechanical ventilator tidal volume.
Keywords: Lung; Humans; Respiratory Distress Syndrome, Adult; Radiography; Respiration, Artificial; APACHE; Survival Rate; Proportional Hazards Models; Adult; Middle Aged; Intensive Care Units; Female; Male
Description: Publisher's copy made available with the permission of the publisher © Australian Society of Anaesthetists
RMID: 0020040665
DOI: 10.1177/0310057X0403200304
Description (link): http://www.aaic.net.au/Article.asp?D=2003327
Appears in Collections:Applied Mathematics publications
Anaesthesia and Intensive Care publications

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