Of the 126 patient charts reviewed, 24 patients met criteria for entrance into the study. The 102 patients who were excluded (1) never fulfilled diagnostic cri­teria for ARDS (41 patients), (2) were extubated on or before the seventh day of ARDS (21 patients), or (3) died before the 14th day of ARDS (40 patients).

Clinical information pertaining to the entire study group is reported in the first column of Table 1. The mean age was 41.4 ±4.1 years and women predominated (14 women vs 10 men). The patients’ underlying clinical disorders and conditions that precipitated ARDS are listed in Table 2.

Table 1—Clinical Features on Day 0 of Study Patients Requiring Intubation for ARDS

All Study
Patients

Group
1

Group
2



(n
—24)

(n
= 10)

(n
= 14)

p Value

Mean age, yr

41.4±4.1

40.5 ±5.6

42.1 ±6.4

NS

Women, n

14

7

7

NS

PEEP value, cm H20

8.8±
1.1

9.9±
1.8

8.0±
1.4

NS

Pa(YFlo2

121.
13.3

113.2±8.1

99.8 ±12.7

NS

Ра0/Рл02

0.20 ±0.02

0.21 ±0.03

0.19 ±0.02

NS

Ctw,
ml/cm H20

24.8±2.2

23.0±2.8

28.0±2.9

NS

Pw, mm Hg

12.5 ±0.5

13.4±0.6

11.9±0.7

NS

BUN, mg/dL

25.0±3.1

26.2 ±4.9

24.
16.2

NS

Serum creatinine,
mg/dL

2.2 ±0.5

2.2±0.7

1.9±0.6

NS

Hematocrit,
%

32.5 ±1.2

33.2 ±2.8

32.0 ±1.0

NS

Leukocyte count,
103 cells/fiL

14.
1.3

16.3 ±2.7

11.
1.5

NS

Ten patients were successfully extubated on or before day 14 of ARDS (group 1), and 14 patients required intubation for ARDS longer than 14 days (group 2). Severity of respiratory failure between group Group 1 patients demonstrated more rapid improve­ment in pulmonary oxygenation compared with group days) and remained in the ICU for 12.5 ±1.3 days (range, 9 to 19 days). No group 1 patient underwent tracheotomy or required reintubation after early ex- tubation. Eight of 10 group 1 patients survived their illness and left the hospital after 26.3 ± 5.7 days (range, 15 to 64 days). Viagra Soft Tabs

Table 2—Underlying Clinical Disorders and Precipitants to ARDS in Study Patients

Group
1

Group
2

(n
= 10)

(n
= 14)

Primary Diagnosis

ARDS
Predisposition

Primary Diagnosis

ARDS
Predisposition

Idiopathic
thrombocytopenia

Post-splenectomy
sepsis

Pneumonia

Pneumonia

Diabetic
ketoacidosis

Aspiration
pneumonia

Esohageal cancer

Pneumonia

Body burn

Body burn

Motor vehicle
accident

Trauma

Gastrointestinal
hemorrhage

Sepsis

Body burn

Body burn

Stabbing

Trauma

Motor vehicle
accident

Trauma

Diabetic
ketoacidosis

Aspiration
pneumonia

Bowel obstruction

Postoperative
sepsis

Motor vehicle
accident

Head injury

Gunshot wound

Trauma

Body burn

Body burn

Ecclampsia

Seizures

Near drowning

Aspiration
pneumonia

Motor vehicle
accident

Trauma

Gastrointestinal
hemorrhage

Hypertransfusion

Acute
glomerulonephritis

Pulmonay
hemorrhage

Pneumonia

Pneumonia

Laparotomy

Postoperative
sepsis

Ectopic pregnancy

Postoperative
sepsis

Laparotomy

Hypertransfusion

Group 2 patients were intubated with translaryngeal tubes for 20.6 ±2.9 days (range, 7 to 51 days, p <0.002). Eleven of 14 group 2 patients underwent tracheotomy after 20.6 ±3.4 days (range, 7 to 51 days) of translaryngeal intubation for ARDS. Tracheotomy was considered first and arrangements initiated for surgery in these 11 patients after 17.5 ±3.8 days of respiratory failure. Three patients had a tracheotomy placed before day 14 (days 7, 12 and 13) because of difficulties with translaryngeal tubes. All three of these patients died after 15, 19 and 48 days of intubation. The remaining three group 2 patients who did not receive a tracheotomy died after 16, 16 and 30 days of translaryngeal intubation. Group 2 patients were main­tained on mechanical ventilation for 42.4 ±8.1 days (p <0.002) and remained in the ICU for 43.4 ±8.0 days (p <0.003). Only four of 14 group 2 patients survived their illnesses and were discharged from the hospital after 62.8 ± 15.7 days (range, 42 to 109 days, p <0.002) of ARDS. The remaining 11 group 2 patients expired after 38.2 ± 8.6 days (range, 16 to 109 days) of ARDS. No group 2 patient underwent attempted extubation before day 28 of ARDS.
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Table 3 Sensitivity and Specificity cf Day 7 Clinical Features in Determining Need for Intubation beyond 14 Days in the Study Patients

Predictive Value

Sensitivity

Specificity

Positive

Negative

(%)

(%)

(%)

(%)

PEEP
>10
cm H20

71

100

100

71

Ра(уРл02<0.40

57

80

80

57

No radiographic
improvement

67

100

100

67

>50%
lung fields with

78

100

100

75

radiographic
alveolar infiltrates

The sensitivity, specificity and predictive values of day 7 clinical features in predicting the need for prolonged intubation are displayed in Table 3.