Etiology and Outcomes of ARDS in a Rural-Urban Fringe Hospital of South India

Abstract

Objectives. Etiology and outcomes of acute lung injury in tropical countries may be different from those of western nations. We describe the etiology and outcomes of illnesses causing acute lung injury in a rural populace. Study Design. A prospective observational study. Setting. Medical ICU of a teaching hospital in a rural-urban fringe location. Patients. Patients ≥13 years, admitted between December 2011 and May 2013, satisfying AECC criteria for ALI/ARDS. Results. Study had 61 patients; 46 had acute lung injury at admission. Scrub typhus was the commonest cause (7/61) and tropical infections contributed to 26% of total cases. Increasing ARDS severity was associated with older age, higher FiO2 and APACHE/SOFA scores, and longer duration of ventilation. Nonsurvivors were generally older, had shorter duration of illness, a nontropical infection, and higher total WBC counts, required longer duration of ventilation, and had other organ dysfunction and higher mean APACHE scores. The mortality rate of ARDS was 36.6% (22/61) in our study. Conclusion. Tropical infections form a major etiological component of acute lung injury in a developing country like India. Etiology and outcomes of ARDS may vary depending upon the geographic location and seasonal illnesses.

Use of corticosteroids in acute respiratory distress syndrome: Perspective from an Indian intensive care unit

“…This can partially be explained by the nature of patients presenting to our tertiary referral center who have often times been admitted at other centers and received multiple doses of antimicrobials. The mortality in our patients was 53.7%, which, despite being comparable to other Indian studies, 10,11,[15][16][17] is significantly higher than the 15-30% noted in Western literature. 2,5 Our study had certain limitations as well.…”

“…10,11,15 Sepsis continues to be the leading cause of ARDS and is often associated with tropical illnesses, including malaria, leptospirosis, dengue, etc., seen in a predominantly male population with occupational exposure to unsanitary environmental conditions. 10,11,15,16 Consistent with these studies, 10,11,16 our patients too showed similar demographic and etiological characteristics, but the microbiological yield of our patients was significantly lesser (17.9%) vs. the 40-50% range noted by our Indian colleagues. This can partially be explained by the nature of patients presenting to our tertiary referral center who have often times been admitted at other centers and received multiple doses of antimicrobials.…”

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

“…2,25 A study of 196 ARDS cases in 14 centres all across Ireland found that low PaO 2 /FiO 2 ratio at baseline was associated with mortality. 25 In an Indian study of 46 ARDS patients classifi ed according to the American European consensus defi nition, 7,26 all the four patients categorised as severe ARDS by Berlin classifi cation died. In our study also all with severe ARDS died.…”

“…Observational studies from India show that mortality associated with ARDS ranges from 36% to 60%. [4][5][6][7] The burden of ARDS on our intensive care units (ICUs) continues to be under appreciated. ARDS is under recognised even in ICUs from high-income countries.…”

Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS)

“…Esteban 2000 used target volumes and pressures that were intermediate between protective and non-protective. Additionally, these trials were conducted in highincome settings, and the aetiology, disease progression and prognosis of ARDS may di er in low-and middle-income settings (Agarwal 2006;George 2014), thereby a ecting applicability of the results of these trials.…”