Prognostic factors in acute respiratory distress syndrome: a retrospective multivariate analysis including prone positioning in management strategy

• Published in: Intensive care medicine 2003-09, Vol.29 (9), p.1435-1441
• Main Authors: VENET, Christophe, GUYOMARC'H, Stephane, ZENI, Fabrice, PINGAT, Juliette, MICHARD, Christophe, LAPORTE, Silvy, BERTRAND, Monique, GERY, Pierre, PAGE, Dominique, VERMESCH, Regine, BERTRAND, Jean Claude
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Care - methods; Emergency and intensive respiratory care; Female; France - epidemiology; Humans; Intensive care; Intensive care medicine; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Outcome and Process Assessment (Health Care); Patient positioning; Pneumonia; Positive-Pressure Respiration - statistics & numerical data; Prognosis; Prone Position; Pulmonary arteries; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - classification; Respiratory Distress Syndrome, Adult - diagnosis; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Analysis
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-003-1856-2

To investigate the prognostic factors in acute respiratory distress syndrome (ARDS) patients focusing on the use of prone positioning (PP). Retrospective study conducted in an intensive care unit of a university hospital. All consecutive mechanically ventilated ARDS patients surviving on day 7 after the diagnosis of ARDS. The study included all ARDS patients who survived more than 7 days after ARDS diagnosis between January 1995 and December 2002. Demographic and respiratory variables were collected on day 1, and the management of ARDS was analyzed during the first 7 days ( n=125). We performed a univariate analysis and a stepwise logistic regression analysis comparing survivors and nonsurvivors on day 28 and at 2 and 6 months. Mortality rates on day 28 and at 2 and 6 months were 21.6%, 32%, and 44% respectively. A SAPS II score less than 49, McCabe score, and the use of PP introduced in the first 7 days of ARDS management appeared to be independently correlated with a decrease in mortality. The SAPS II score, the McCabe score, and use of PP are independently correlated with the outcome in ARDS patients.