Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients

Byline: E. Roupie (1), E. Lepage (2), M. Wysocki (3), J.-Y. Fagon (4), J. Chastre (5), D. Dreyfuss (6), H. Mentec (7), J. Carlet (8), C. Brun-Buisson (1), F. Lemaire (1), L. Brochard (1) Keywords: Key words Acute lung injury; Acute respiratory distress syndrome; Mechanical ventilation Abstract: Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up. Settings: Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF). Patients: All the patients entering the ICUs during a 14-day period were screened prospectively. Hypoxemic patients, defined as having a PaO.sub.2/FIO.sub.2 ratio (P/F) of 300 mmHg or less and receiving mechanical ventilation, were classified into three groups, according to the Consensus Conference on ARDS: group 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on the chest X-ray) group 2 to acute lung injury (ALI) without having criteria for ARDS (200 < P/F a$? 300 mmHg and bilateral infiltrates) and group 3 to patients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups. Results: Nine hundred seventy-six patients entered the ICUs during the study period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, ARDS, ALI and group 3 patients amounted, respectively, to 6.9 % (67), 1.8 % (17) and 13.3 % (129) of the patients, and represented 31.5 %, 8.1 % and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41 % and was significantly higher in ARDS patients than in the others (60 % vs 31 % p < 0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury mortality was significantly lower (40.5 %) than in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were significantly associated with mortality, while the association with immunosuppression revealed only a trend (p = 0.06). Conclusions: In this survey we found that very few patients fulfilled the ALI non-ARDS criteria and that the mortality of the group with ARDS was high. Author Affiliation: (1) Medical Intensive Care Unit, INSERM U492, Hopital Henri Mondor, AP-HP, Paris XII University, F-94 010 Creteil, France e-mail: laurent.brochard@hmn. ap-hop-paris.fr, Tel. + 33-1-49812545 Fax: + 33-1-42 079943, FR (2) Medical Information Unit, Hopital Henri Mondor, AP-HP, Paris XII University, F-94 010 Creteil, France, FR (3) Medical Intensive Care Unit, Institut Mutualiste Montsouris Jourdan, Paris (4) Medical Intensive Care Unit, Hopital Broussais, Paris (5) Medical Intensive Care Unit, Hopital Bichat-Claude Bernard, Paris (6) Medical Intensive Care Unit, Hopital, A. Beclere, Clamart (7) Medical Intensive Care Unit, Hopital V. Dupouy, Argenteuil (8) Medical Intensive Care Unit, Hopital Saint-Joseph, Paris Article note: Received: 21 September 1998 Final revision received: 3 February 1999 Accepted: 3 May 1999