Table 1.
Patient characteristics and outcomes
| Patient characteristic or outcome | All patients with ARDS (N = 234) | Patients with ARDS, without severe ACP (N = 168) | Patients with ARDS, with severe ACP (N = 66) | P value |
|---|---|---|---|---|
| Age (years) (mean ± SD) | 62.3 ± 14.3 | 62.0 ± 14.7 | 64.8 ± 12.9 | 0.180 |
| Female sex (%) | 88 (37.6) | 65 (38.7) | 23 (34.9) | 0.654 |
| APACHE II score (mean ± SD) | 26.8 ± 8.3 | 26.7 ± 8.1 | 27.3 ± 8.7 | 0.615 |
| Arterial blood gas measurement | ||||
| PF ratio (mmHg) (mean ± SD) | 171 ± 67 | 172 ± 69 | 169 ± 63 | 0.801 |
| pH (mean ± SD) | 7.33 ± 0.12 | 7.34 ± 0.11 | 7.31 ± 0.13 | 0.065 |
| PaCO2 (mmHg) (mean ± SD) | 43 ± 14 | 42 ± 13 | 47 ± 16 | 0.001 |
| ARDSa (%) | ||||
| Mild | 83 (35.5) | 59 (35.1) | 24 (36.4) | 0.892 |
| Moderate | 108 (46.2) | 79 (47.0) | 29 (43.9) | |
| Severe | 43 (18.4) | 30 (17.9) | 13 (19.7) | |
| Primary diagnosis (%) | ||||
| Pneumonia | 208 (88.9) | 151 (89.9) | 57 (86.4) | 0.489 |
| Non-pneumonia sepsis | 26 (11.1) | 17 (10.1) | 9 (13.6) | |
| Comorbidities (%) | ||||
| Diabetes mellitus | 81 (34.6) | 61 (36.3) | 20 (30.3) | 0.446 |
| Hypertension | 115 (49.2) | 86 (51.2) | 29 (43.9) | 0.384 |
| Ischaemic heart disease | 55 (23.5) | 43 (25.6) | 12 (18.2) | 0.304 |
| Chronic heart failure | 9 (3.9) | 7 (4.2) | 2 (3.0) | 1.000 |
| Asthma | 14 (6.0) | 10 (6.0) | 4 (6.1) | 1.000 |
| COPD | 17 (7.3) | 13 (7.7) | 4 (6.1) | 0.785 |
| Bronchiectasis | 10 (4.3) | 7 (4.2) | 3 (4.6) | 1.000 |
| Chronic renal failure | 38 (16.2) | 27 (16.1) | 11 (16.7) | 1.000 |
| Chronic liver disease | 10 (4.3) | 8 (4.8) | 2 (3.0) | 0.729 |
| Stroke | 16 (6.8) | 13 (7.7) | 3 (4.6) | 0.566 |
| Cancer | 39 (16.7) | 31 (18.5) | 8 (12.1) | 0.330 |
| Actual body weight (kg) (mean ± SD) | 63.3 ± 17.2 | 63.4 ± 16.6 | 62.9 ± 18.6 | 0.840 |
| Ventilation modes (%) | ||||
| Nil ventilation | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0.942 |
| CPAP | 17 (7.3) | 13 (7.7) | 4 (6.1) | |
| NIV | 10 (4.3) | 7 (4.2) | 3 (4.6) | |
| Invasive | 207 (88.5) | 148 (88.1) | 59 (89.4) | |
| Respiratory parameters at time of BCCE | ||||
| Respiratory rate (breaths/min) (mean ± SD) | 24 ± 3 | 24 ± 4 | 24 ± 2 | 0.274 |
| Tidal volume (ml) (mean ± SD) | 408 ± 113 | 409 ± 113 | 407 ± 112 | 0.931 |
| Tidal volume (ml/kg IBW) (mean ± SD) | 7 ± 2 | 7 ± 2 | 7 ± 3 | 0.276 |
| PEEP (cm H2O) (mean ± SD) | 7 ± 3 | 6 ± 3 | 7 ± 3 | 0.089 |
| Plateau pressureb (cm H2O) (mean ± SD) | 21 ± 3 | 21 ± 2 | 21 ± 5 | 0.507 |
| Complianceb (ml/cm H2O) (mean ± SD) | 31 ± 14 | 29 ± 12 | 34 ± 18 | 0.047 |
| On vasoactive agents (%) | ||||
| Any agentc | 77 (32.9) | 55 (32.7) | 22 (33.3) | 1.000 |
| Dopamine | 4 (1.7) | 2 (1.2) | 2 (3.0) | 0.316 |
| Noradrenaline | 73 (31.2) | 52 (31.0) | 21 (31.8) | 1.000 |
| Dobutamine | 2 (0.9) | 2 (1.2) | 0 (0.0) | 1.000 |
| Vasopressin | 1 (0.4) | 1 (0.6) | 0 (0.0) | 1.000 |
| BCCE-detected major abnormalities (%) | ||||
| Left ventricular ejection fraction < 40% | 38 (16.2) | 28 (16.7) | 10 (15.2) | 0.846 |
| Severe acute cor pulmonale | 66 (28.2) | 0 (0.0) | 66 (100.0) | < 0.001 |
| Any major abnormalities | 94 (40.2) | 28 (16.7) | 66 (100.0) | < 0.001 |
| LOS, ICU (days), median (IQR) | 7 (4–12) | 7 (4–12) | 7 (3–13) | 0.931 |
| LOS, hospital (days), median (IQR) | 17.5 (9–28) | 18 (9–26) | 17 (8–31) | 0.837 |
| Mortality, ICU (%) | 62 (26.5) | 37 (22.0) | 25 (37.9) | 0.021 |
| Mortality, hospital (%) | 75 (32.1) | 47 (28.0) | 28 (42.4) | 0.043 |
ACP Acute cor pulmonale (severe ACP is defined as right ventricular dilatation with the right-to-left ventricular size ratio ≥ 1 in end diastole at the papillary muscle level and interventricular septal straightening/paradoxical motion), APACHE II Acute Physiology and Chronic Health Evaluation II, ARDS acute respiratory distress syndrome, BCCE basic critical care echocardiography, COPD chronic obstructive pulmonary disease, CPAP continuous positive airway pressure, IBW ideal body weight. For males, IBW = 50 + 2.3 kg for each increment of 2.54 cm (1 inch) in length over 152.4 cm (5 feet). For females, IBW = 45.5 + 2.3 kg for each increment of 2.54 cm (1 inch) in length over 152.4 cm (5 feet), ICU intensive care unit, IQR interquartile range, LOS length of stay, PEEP positive end-expiratory pressure, SD standard deviation, NIV non-invasive ventilation
aARDS severity according to the Berlin Definition: mild (PF ratio 201–300 mmHg), moderate (PF ratio 101–200 mmHg) and severe (PF ratio 100 mmHg or less), where PF ratio is the ratio of arterial oxygen partial pressure (mmHg) to inspired oxygen fraction
bData only for the intubated patients (N = 207)
cPatients could be on more than one vasoactive agent