CLINICAL PROFILE OF ARDS, PROSPECTIVE STUDY AT TERTIARY HEALTH CENTRE, KOLAR
Anitha Aswathanarayana*,Sagar V, Raghavendra Prasad BN, Srinivas SV, Spoorti Vulavala
Background: ARDS is the most common presentation in ICU’s worldwide more so in developing countries. 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. AECC criteria includes PCWP estimation, an invasive procedure for diagnosing ARDS. The aim of the current study is to evaluate the clinical profile and associated risk factors and effect of comorbid condition on ARDS using the criteria without invasive procedure. Objectives: 1. To study the clinical profile and in hospital outcome of acute respiratory distress syndrome (ARDS) in adult patients admitted to intensive care unit (ICU). 2. To study risk factors associated with ARDS. 3. To study the influence of co-morbid conditions on the outcome of ARDS. Materials and Methods: Total 50 patients aged more than 18years and who gave informed consent, satisfying AECC criteria for ARDS were included. Patients were screened for presence of left atrial hypertension both clinically and by echocardiography and were excluded in its presence.PaO2/FiO2 ratio calculated and appropriate investigations were done and statistical analysis done using SPSS software version 17.0.Means of continuous variable were compared by student t test or Mann X Whitney U test. Discrete variables were compared by chi square and Fisher exact test. Results: The parameters showing statistical significance with mortality in our study are pO2 (p=.034), HCO3(p=<0.001), FiO2(P=0.095), PaO2/FiO2(<0.001),PEEP(<0.001), SERUM CREATININE(P=0.035). Use of inotropes and transfusion of blood and blood products was higher in the death patients compared to recovered patients. Conclusion: Out of 50 patients included in our study, males are 58% and females 42%. Common age group affected is 30 and less. Causes of ARDS are Pneumonia (38.0%), Sepsis (20.0%), acute febrile illness with MODS (20.0%), Dengue (12.0%), Malaria (6.0%), Pancreatitis (2.0%) and Typhoid (2.0%). Fever and Breathlessness were the commonest presenting features. Risk factors and co-morbidities in our patients of ARDS are Diabetes, Hypertension, Smoking and alcohol, but there is no statistically significant difference on outcome. Mortality in our study is 64%.. Factors showing strong correlation with mortality on outcome of the patient are PEEP, pO2, Acidosis, Pao2/Fio2, renal failure, liver failure, use of inotropes and duration of stay.
Keywords: ARDS, PaO2/FiO2, AECC criteria.
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