Aetiology and Short-Term Outcome of Acute Respiratory Distress Syndrome: A Real-World Experience from a Medical Intensive Care Unit in Southern India

Abstract

Background Acute respiratory distress syndrome (ARDS) is a highly fatal syndrome especially in resource constrained settings. In this study we prospectively studied the aetiology of ARDS and its short-term outcome. Methods Consecutive adults with suspected ARDS were screened. ARDS was diagnosed by the Berlin criteria. Aetiology was determined clinically, and by imaging and microbiological investigations. Patients presenting with fever, prominent cough and expectoration had a throat swab tested for influenza H1N1 virus. Outcome was discharge from hospital or death. Results A total of 42 patients, mean age 42.6 years, were studied. All received mechanical ventilation. Thirteen (31%) had pulmonary ARDS: H1N1 virus infection (n = 5), pneumonia (n = 7) and tuberculosis (n = 1). Twenty nine (69%) had extrapulmonary ARDS: sepsis (n = 16) and scrub typhus (n = 8). Thirty three (79%) died, of the nine survivors scrub typhus was diagnosed in seven patients. Conclusion The aetiology of ARDS in tropical medical setting is infection related. ARDS due to scrub typhus appeared to be mild with good outcome.

Acute Respiratory Distress Syndrome in the Tropics: There is Much to Learn!

“…In this study, 11 hospital mortality was 35%, 40% and 46% in patients with mild, moderate and severe ARDS, respectively. The mortality in the present study 12 (33 out of 42; 79%) was much higher than that reported in other recent studies where the in-hospital hospital mortality was 63 out of 170 (37%) 13 and 34 out of 75 (45%), 10 and 28-day mortality was 36 out of 64 (56%). 14 Balakrishnan et al 12 attributed this high mortality to seasonal rise in H1N1 cases, and the fact that some patients were ventilated outside the ICU because of limited number of beds in ICU and transferred later on to ICU, and severe underlying organ dysfunction at admission.…”

“…The patients were evaluated till discharge from hospital or till death; the median (interquartile range) duration of hospital stay was 6 (3.75-10) days. There were a large number of patients with viral pneumonia compared with other Indian studies, 10,13,14 which was explained by authors 12 to be due to seasonal increase in the place of study. In extrapulmonary ARDS, following sepsis, scrub typhus accounted for the majority of cases, which was attributed to endemicity of the disease.…”

“…The prospective study by Balakrishnan et al 12 featured in this issue of the Journal of the Royal College of Physicians of Edinburgh, attempted to describe the aetiology and short-term outcome of ARDS (n = 42; mean age 42.6 ± 15.3 years; 21 males) in the medical intensive care unit (MICU) at their tertiary care teaching hospital located in Puducherry, in south India. Of these, 22 patients has ARDS at admission and the rest developed ARDS during their inhospital stay.…”

“…Certain issues related to the study by Balakrishnan et al 12 need consideration. It is a single-centre study with a small sample size.…”

“…The study by Balakrishnan et al 12 reiterates the importance of recognising treatable tropical infections as the aetiological causes of ARDS, as early initiation of appropriate antibiotic treatment has potential to signifi cantly decrease the morbidity and mortality in patients with ARDS owing to these causes. Balakrishnan et al 12 also reported the potential usefulness of critical illness scoring systems, such as APACHE II and SOFA score in predicting prognosis. These critical illness scoring systems have been validated in intensive care units (ICUs) outside India.…”