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Abstract

Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU. Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital. The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS. Results: There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria. Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively. Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P). Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression. All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg. Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy. Mortality rate was 79% in the ICU. The patients required 12 ± 10 days on MV, ranging from 1 to 55 days. The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively. There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS. The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively. Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe. There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS. The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies.

Profile and severity of the patients of intensive care units: prospective application of the APACHE II index

“…ICUs, found mortality rates of 11, 33.9, 46.9 and 52.2% respectively in patients with systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock (15) . Another Brazilian study analyzed data from 75 ICUs in different regions and found mortality rates of 16.7% for sepsis, 34% for severe sepsis and 65.3% for septic shock (16) .…”

Análise da qualidade de vida após a alta hospitalar em sobreviventes de sepse grave e choque séptico

“…Por outro lado, não comparamos a população séptica com portadores de outras doenças. O declínio de qualidade de vida pósalta hospitalar de pacientes sépticos observado no nosso e em outros estudos é similar ao que se observa em pacientes com lesão pulmonar aguda (LPA) ou síndrome do desconforto respiratório agudo (SDRA), doença pulmonar obstrutiva crônica (DPOC) e insuficiência cardíaca congestiva (ICC) (10,(25)(26)(27), assim como em outras doenças agudas graves (7,(28)(29)(30)(31)(32). Considerando que a sepse é uma das principais complicações dos pacientes graves e a principal causa de LPA/SDRA, não é possível determinar se os efeitos observados a longo prazo são decorrência exclusiva da sepse, da LPA/SDRA ou da doença aguda subjacente (10).…”

Sepsis in cancer patients admitted in the ICU: epidemiology, pathophysiology, and biomarkers

“…The BASES study showed an incidence of sepsis of 57 per 1,000 inhabitants, with a higher incidence of neoplasias in groups with infection compared to groups with systemic inflammatory response without infection, 18.3 and 12.1%, respectively. 15 In 65 ICUs in Brazil, high mortality due to sepsis was detected at 28 days in 2006; 46.6% with description of neoplasia in 14% of the patients, with 8% under immunosuppressive treatment. 16 The demand for hospitalization in the ICU for patients with neoplasia varied in different studies between 15% 14 and 21.5% 5 ; 85% had solid neoplasia and 25% hematological neoplasia; 25% of the solid tumors were metastatic.…”