Skip to main content
SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To investigate the prognostic factors in acute respiratory distress syndrome (ARDS) patients focusing on the use of prone positioning (PP).

Design and setting

Retrospective study conducted in an intensive care unit of a university hospital.

Patients

All consecutive mechanically ventilated ARDS patients surviving on day 7 after the diagnosis of ARDS.

Methods

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.

Results

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.

Conclusions

The SAPS II score, the McCabe score, and use of PP are independently correlated with the outcome in ARDS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ashbaugh DG, Bigelow DB, Petty TL, Levine BE (1967) Acute respiratory distress in adults. Lancet II:319–323

    Google Scholar 

  2. Krafft P, Fridrich P, Pernerstorfer T, Fitzgerald RD, Koc D, Schneider B, Hammerle AF, Steltzer H (1996) The acute respiratory distress syndrome: definitions, severity and clinical outcome. An analysis of 101 clinical investigations. Intensive Care Med 22:519–529

    CAS  PubMed  Google Scholar 

  3. Steltzer H, Krafft P (1999) Improved outcome of ARDS patients: are we really performing better? Intensive Care Med 25:887–889

    Google Scholar 

  4. Esteban A, Alia I, Gordo F, de Pablo R, Suarez J, Gonzalez G, Blanco J (2000) Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. For the Spanish Lung Failure Collaborative Group. Chest 117:1690–1696

    Google Scholar 

  5. Ferring M, Vincent JL (1997) Is outcome from ARDS related to the severity of respiratory failure? Eur Respir J 10:1297–1300

    Google Scholar 

  6. Luhr OR, Karlsson M, Thorsteinsson A, Rylander C, Frostell CG (2000) The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation. Intensive Care Med 26:508–517

    Article  CAS  PubMed  Google Scholar 

  7. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F (1998) Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 158:1076–1081

    Google Scholar 

  8. Roupie E, Lepage E, Wysocki M, Fagon JY, Chastre J, Dreyfuss D, Mentec H, Carlet J, Brun-Buisson C, Lemaire F, Brochard L (1999) Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF Collaborative Group on Mechanical Ventilation. Societe de Reanimation de Langue Francaise. Intensive Care Med 25:920–929

    CAS  PubMed  Google Scholar 

  9. Squara P, Dhainaut JF, Artigas A, Carlet J, Group at ECAW (1998) Hemodynamic profile in severe ARDS: results of the European Collaborative ARDS Study. Intensive Care Med 24:1018–1028

    Google Scholar 

  10. Valta P, Uusaro A, Nunes S, Ruokonen E, Takala J (1999) Acute respiratory distress syndrome: frequency, clinical course, and costs of care. Crit Care Med 27:2367–2374

    CAS  PubMed  Google Scholar 

  11. Vieillard-Baron A, Girou E, Valente E, Brun-Buisson C, Jardin F, Lemaire F, Brochard L (2000) Predictors of mortality in acute respiratory distress syndrome. Focus on the role of right heart catheterization. Am J Respir Crit Care Med 161:1597–1601

    Google Scholar 

  12. Zilberberg MD, Epstein SK (1998) Acute lung injury in the medical ICU: comorbid conditions, age, etiology, and hospital outcome. Am J Respir Crit Care Med 157:1159–1164

    Google Scholar 

  13. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308

    PubMed  Google Scholar 

  14. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR (1998) Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome N Engl J Med 338:347–354

    Google Scholar 

  15. Gattinoni L TG, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P, Brazzi L, Latini R, for the PRONE-SUPINE STUDY GROUP (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–573

    Google Scholar 

  16. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, LeGall JR, Morris A, Spragg R (1994) Report of the American-European consensus conference on ARDS: definitions, mechanisms, relevant outcomes and clinical trial coordination. The Consensus Committee. Intensive Care Med 20:225–232

  17. McCabe WR, Jackson GG (1962) Gram negative bacteremia etiology and ecology. Arch Intern Med 110:847–852

    Google Scholar 

  18. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    PubMed  Google Scholar 

  19. Dellinger RP, Zimmerman JL, Taylor RW, Straube RC, Hauser DL, Criner GJ, Davis K Jr, Hyers TM, Papadakos P (1998) Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group. Crit Care Med 26:15–23

    CAS  PubMed  Google Scholar 

  20. Troncy E, Collet JP, Shapiro S, Guimond JG, Blair L, Ducruet T, Francoeur M, Charbonneau M, Blaise G (1998) Inhaled nitric oxide in acute respiratory distress syndrome: a pilot randomized controlled study. Am J Respir Crit Care Med 157:1483–1488

    Google Scholar 

  21. Venet C Guyomarc'h S, Migeot C, Bertrand M, Gery P, Page D, Vermesch R, Bertrand JC, Zeni F (2001) The oxygenation variations related to prone positioning during mechanical ventilation: a clinical comparison between ARDS and non ARDS hypoxemic patients. Intensive Care Med 27:1352–1359

    Google Scholar 

  22. Blanch L, Mancebo J, Perez M, Martinez M, Mas A, Betbese AJ, Joseph D, Ballus J, Lucangelo U, Bak E (1997) Short-term effects of prone position in critically ill patients with acute respiratory distress syndrome. Intensive Care Med 23:1033–1039

    Google Scholar 

  23. Chatte G, Sab JM, Dubois JM, Sirodot M, Gaussorgues P, Robert D (1997) Prone position in mechanically ventilated patients with severe acute respiratory failure. Am J Respir Crit Care Med 155:473–478

    Google Scholar 

  24. Jolliet P, Bulpa P, Ritz M, Ricou B, Lopez J, Chevrolet JC (1997) Additive beneficial effects of the prone position, nitric oxide, and almitrine bismesylate on gas exchange and oxygen transport in acute respiratory distress syndrome. Crit Care Med 25:786–794

    Google Scholar 

  25. Jolliet P, Bulpa P, Chevrolet JC (1998) Effects of the prone position on gas exchange and hemodynamics in severe acute respiratory distress syndrome. Crit Care Med 26:1977–1985

    CAS  PubMed  Google Scholar 

  26. Martinez M, Diaz E, Joseph D, Villagra A, Mas A, Fernandez R, Blanch L (1999) Improvement in oxygenation by prone position and nitric oxide in patients with acute respiratory distress syndrome. Intensive Care Med 25:29–36

    Google Scholar 

  27. Papazian L, Bregeon F, Gaillat F, Thirion X, Gainnier M, Gregoire R, Saux P, Gouin F, Jammes Y, Auffray JP (1998) Respective and combined effects of prone position and inhaled nitric oxide in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 157:580–585

    Google Scholar 

  28. Fridrich P, Krafft P, Hochleuthner H, Mauritz W (1996) The effects of long-term prone positioning in patients with trauma-induced adult respiratory distress syndrome. Anesth Analg 83:1206–1211

    CAS  PubMed  Google Scholar 

  29. Nakos G, Tsangaris I, Kostanti E, Nathanail C, Lachana A, Koulouras V, Kastani D (2000) Effect of the prone position on patients with hydrostatic pulmonary edema compared with patients with acute respiratory distress syndrome and pulmonary fibrosis. Am J Respir Crit Care Med 161:360–368

    Google Scholar 

  30. Stocker R, Neff T, Stein S, Ecknauer E, Trentz O, Russi E (1997) Prone positioning and low-volume pressure-limited ventilation improve survival in patients with severe ARDS. Chest 111:1008–1017

    Google Scholar 

  31. Peduzzi P, Concato J, Kemper E, Holford R, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Polyvalent Intensive Care Unit, Bellevue University Hospital, 42055, Saint Etienne Cedex 2, France

    Christophe Venet, Stephane Guyomarc'h, Juliette Pingat, Christophe Michard, Monique Bertrand, Pierre Gery, Dominique Page, Regine Vermesch, Jean Claude Bertrand, Jean Claude Bertrand & Fabrice Zeni

  2. Clinical Pharmacology Unit, Bellevue University Hospital, 42055, Saint Etienne Cedex 2, France

    Silvy Laporte

Authors
  1. Christophe Venet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephane Guyomarc'h
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juliette Pingat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christophe Michard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Silvy Laporte
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Monique Bertrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pierre Gery
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dominique Page
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Regine Vermesch
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jean Claude Bertrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Fabrice Zeni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christophe Venet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Venet, C., Guyomarc'h, S., Pingat, J. et al. Prognostic factors in acute respiratory distress syndrome: a retrospective multivariate analysis including prone positioning in management strategy. Intensive Care Med 29, 1435–1441 (2003). https://doi.org/10.1007/s00134-003-1856-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-1856-2

Keywords

Search

Navigation