High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation.
Intensive Care Med
; 23(8): 819-35, 1997 Aug.
Article
en En
| MEDLINE
| ID: mdl-9310799
ABSTRACT
OBJECTIVE:
We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in acute respiratory distress syndrome (ARDS).DESIGN:
Uncontrolled prospective trial.SETTING:
One university hospital intensive care department. PATIENTS ANDPARTICIPANTS:
122 patients with ARDS, consecutively admitted to the ICU.INTERVENTIONS:
ARDS was treated according to a criteria-defined clinical algorithm. The algorithm distinguished two main treatment groups The AT-sine-ECMO (advanced treatment without extracorporeal membrane oxygenation) groups (n = 73) received a treatment consisting of a set of advanced non-invasive treatment options, the ECMO treatment group (n = 49) received additional extracorporeal membrane oxygenation (ECMO) using heparin-coated systems. MEASUREMENTS ANDRESULTS:
The groups differed in both APACHE II (16 +/- 5 vs 18 +/- 5 points, p = 0.01) and Murray scores (3.2 +/- 0.3 vs 3.4 +/- 0.3 points, p = 0.0001), the duration of mechanical ventilation prior to admission (10 +/- 9 vs 13 +/- 9 days, p = 0.0151), and length of ICU stay in Berlin (31 +/- 17 vs 50 +/- 36 days, p = 0.0016). Initial PaO2/FIO2 was 86 +/- 27 mm Hg in AT-sine-ECMO patients that improved to 165 +/- 107 mm Hg on ICU day 1, while ECMO patients showed an initial PaO2/FIO2 of 67 +/- 28 mm Hg and improvement to 160 +/- 102 mm Hg was not reached until ICU day 13. QS/QT was significantly higher in the ECMO-treated group and exceeded 50% during the first 14 ICU days. The overall survival rate in our 122 ARDS patients was 75%. Survival rates were 89% in the AT-sine ECMO group and 55% in the ECMO treatment group (p = 0.0000).CONCLUSIONS:
We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high survival rates can be achieved.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Síndrome de Dificultad Respiratoria
/
Algoritmos
/
Oxigenación por Membrana Extracorpórea
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
Intensive Care Med
Año:
1997
Tipo del documento:
Article
País de afiliación:
Alemania