The Effects Of Different Treatment Strategies On The Prognosis Of ARDS Patients: A Retrospective Study

Objective: To explore the effects of different treatment strategies on theprognosis of ARDS patients with a retrospective study.Methods: Patients who were admitted to Chengdu Military General Hospitalfrom January2008to December2011and clearly diagnosed as ARDS wereanalyzed retrospectively.(1) Screening strategies and processes: the originalmedical records of ARDS cases were brought up from the medical recordslibrary and screened in line with Berlin definition of ARDS in2011, as well asthe inclusion and exclusion criteria.(2) CRF was used to collect theinformation of each patient including the common information, vital signs,laboratory test results, predisposing factors, measures such as mechanicalventilation and anti-infective treatment, the survival rate, duration of ICU stay,medical costs and other indicators of all ARDS patients. All patients wereevaluated with APACHE II and SOFA scores on the first day of ARDS.(3) Themain indices in the study including:①the duration of mechanical ventilation;②the length of ICU stay;③the average length of stay in hospital;④the28-day survival;⑤the medical cost.(4) Data were summarized andstatistically analyzed with SPSS16.0,and results were expressed as x SD.Count data were analyzed using X2test, and measurement data using t test. P <0.05was considered being statistically significant.Results:117ARDS patients were finally enrolled in the statistical analysis. Themain results were as following:(1) the epidemiological characteristics ofARDS patients:79males and38females, male to female ratio2.08:1. Thelowest incidence of ARDS was in the age group of19-29years, the highest inthe age group60-75years. The mean age of ARDS patients was51.89±13.92years. Among the predisposing factors, the top three were lung infection(32.48%), shock (17.09%) and severe pancreatitis (16.24%). On the first day ofARDS, the average score of APACHE II was21.25±7.27, the average score ofSOFA was8.68±3.49. Mild ARDS patients22cases (18.80%), moderate77cases (65.81%), and severe18cases (15.39%) according to classification ofseverity in Berlin definition.(2) The effects of treatment strategies on theprognosis of ARDS patients:①the duration of ICU stay and medical costsof the mechanical ventilation group were higher than that in the non-mechanicalventilation group. The28-day survival rate, average length of stay were notdifferent in the two groups. The duration of mechanical ventilation and the28-day survival rate of the protective ventilation group were better than that inthe non-protective ventilation group, while the average duration ofhospitalization, duration of ICU stay and medical costs were not different in thetwo groups. Protective ventilation could reduce the incidence of complicationssuch as VAP, MODS and pneumothorax.②The duration of mechanicalventilation, medical costs, and28-day survival rate of the liquid limit group were better than that in the non-liquid limit group. There were no difference inthe duration of ICU stay and the average length of stay between two groups.The28-day survival and the bacterial clearance rate in the optimizedanti-infective group were better than that in the non-optimized anti-infectivegroup. The duration of mechanical ventilation, ICU stay, average length ofhospital stay, medical cost of the non-optimized anti-infective group were betterthan that in the optimized anti-infective group.③The duration of mechanicalventilation, the28-day survival rate of the hormone treatment group were betterthan that in the non-hormone treatment group. However, there were nodifference in the duration of ICU stay, the average length of hospital stay.(4)The duration of mechanical ventilation and medical costs of the non-bloodpurification group were better than that of the blood purification group.(3)Factors affecting the survival of ARDS patients: APACHE II score, SOFAscore ARDS diagnosis time, fluid restriction, the optimized anti-infectivetherapy, hormone treatment and other risk factors affected the prognosis ofARDS; SOFA score, the ARDS diagnosis time and the optimized anti-infectivetherapy were both an independent risk factor affecting the prognosis of ARDSindividually.Conclusions:(1) The clinical epidemiological characteristics ARDS: Higherincidence among males than females, and can occur at all ages.The top three thepredisposing factors are pulmonary infection, shock and severe pancreatitis;moderate severity make up the highest proportion of ARDS patients according to Berlin definition.(2) Mechanical ventilation is an important measure for thetreatment of ARDS patients.Lung protective ventilation strategy can shorten theduration of mechanical ventilation for ARDS patients, and can significantlyimprove28-day survival rate.(3) Fluid restriction strategy can shorten theduration of mechanical ventilation, improve28-day survival rate, and canreduce hospital costs of ARDS patients.(4) The bacterial clearance rate and the28-day survival rate can be significantly improved by the optimizedanti-infection treatment of ARDS patients.(5) Low dosage and short course ofglucocorticoid treatment in the early stage can shorten the duration ofmechanical ventilation, the28-day survival rate and can reduce medical costsfor ARDS patients.(6) The risk factors affecting the prognosis of ARDSincluding APACHE II score, SOFA score, the diagnosis time, fluid restriction,the optimized anti-infective treatment and the early low-dosage glucocorticoidtreatment, and SOFA score.Diagnosis time and optimized anti-infectiontreatment can affect the prognosis of ARDS as independent risk factorindividually.