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PMID: 8814466 Published · ppublish English Journal Article Meta-Analysis

The acute respiratory distress syndrome: definitions, severity and clinical outcome. An analysis of 101 clinical investigations.

Intensive care medicine ·Vol. 22 ·No. 6 ·1996-06-00 ·Pages 519-29

Krafft P, Fridrich P, Pernerstorfer T, Fitzgerald RD, Koc D, Schneider B, Hammerle AF, Steltzer H

Abstract

To determine possible changes in outcome from acute respiratory distress syndrome (ARDS) and to compare severity of lung injury and methods of treatment from 1967 to 1994. Computerized (Medline, Current Contents) and manual (Cumulated Index Medicus) literature search using the key word and/or title ARDS. Only clinical studies published as full papers reporting data on both patient mortality (survival) and oxygenation index (PaO2/FIO2) were included. Single case reports, abstracts, reviews and editorials were excluded from evaluation. Relevant data were extracted in duplicate, followed by quality checks on approximately 80% of data extracted. 101 papers reporting on 3264 patients were included: 48 studies (2207 patients) were performed in the USA, 43 studies (742 patients) in Europe and 10 studies (315 patients) elsewhere. Mortality reported in these studies was 53 +/- 22% (mean +/- SD), with no apparent trend towards a higher survival (1994: 22 studies, mortality 51 +/- 19%). The mean PaO2/FIO2 ratio remained unchanged throughout the observation period (118 +/- 47 mmHg). No correlation could be established between outcome and PaO2/FIO2 or lung injury score. Patients who underwent pressure-limited ventilation had a significantly lower mortality (35 +/- 20%) than patients on volume-cycled ventilation (54 +/- 22%) or patients for whom there was no precise information on ventilatory support (59 +/- 19%). Significantly lower PaO2/FIO2 ratios (61 +/- 17 mmHg) were observed in patients prior to extracorporeal lung assist, together with mortality rates in the range of those for conventionally treated patients (55 +/- 22%). The mortality of ARDS patients remained constant throughout the period studied. Therefore, the standard for outcome in ARDS should be a mortality in the 50% range. Neither PaO2/FIO2 ratio nor lung injury score was a reliable predictor for outcome in ARDS. Patients might benefit from pressure-limited ventilatory support, as well as extracorporeal lung assist. Since crucial data were missing in most clinical studies, thus preventing direct comparison, we emphasize the importance of using standardized definitions and study entry criteria.

MeSH Terms
APACHE Analysis of Variance Humans Mortality/trends Oxygen/blood Patient Selection Respiration, Artificial/methods Respiratory Distress Syndrome/classification,mortality,therapy Severity of Illness Index Statistics, Nonparametric Treatment Outcome
Chemicals
Oxygen
Authors & Affiliations
8 authors, click to expand affiliations / ORCID
Krafft P
Department of Anaesthesiology and Intensive Care Medicine, University of Vienna, Austria.
Fridrich P
Pernerstorfer T
Fitzgerald R D
Koc D
Schneider B
Hammerle A F
Steltzer H
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Article Info
Journal
Intensive care medicine
Abbr.
Intensive Care Med
ISSN
0342-4642
DOI
10.1007/BF01708091
Published
1996-06-00
Pages
519-29
Language
English
Region
United States
NLM ID
7704851
Subset
IM
Corrections
CommentIn
PMID: 8814465
External Links
PubMed source DOI: 10.1007/BF01708091 View journal details
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