Survival Predictors in Patients with Acute Respiratory Distress Syndrome and Underlying Chronic Respiratory Diseases

急性呼吸窘迫症候群併有慢性肺疾病患之存活預測因子

黃繼賢(Chi-Hsien Huang) ； 張克威(Ko-Wei Chang) ； 邱立忠(Li-Chung Chiu) ； 張志豪(Chih-Hao Chang) ； 李忠恕(Chung-Shu Lee) ； 胡漢忠(Han-Chung Hu) ； 黃崇旂(Chung-Chi Huang) ； 高國晉(Kuo-Chin Kao)

《胸腔醫學》 34卷6期 (2019/12) Pp. 230-239

摘要

Introduction: Acute respiratory distress syndrome (ARDS) is a syndrome of severe hypoxemia with various risk factors. Chronic respiratory diseases are chronic diseases of the airways and lungs. In most of the large trials of ARDS, patients with chronic respiratory diseases were excluded. The aim of this study was to investigate the outcomes of patients with both ARDS and chronic respiratory diseases. Material and Methods: We retrospectively collected patients documented with ARDS and chronic respiratory diseases at a tertiary care center from October 2012 to May 2015. Baseline clinical features, severity and causes of ARDS, parameters of mechanical ventilator use and the survival outcome were recorded. Results: We enrolled 73 patients with ARDS and chronic respiratory diseases; 47.9% had COPD. The overall hospital mortality rate was 67.1% (49/73). In patients with mild, moderate and severe ARDS, the hospital mortality rates were 76.4% (13/17), 58.1% (18/31), and 72% (18/25), respectively (p=0.23). There was no significant difference in positive end-expiratory pressure, peak airway pressure and dynamic driving pressure between non-survivors and survivors. Tidal volume was significantly higher in non-survivors than in survivors (8.0 ± 1.7 ml/kgw vs. 7.2 ± 1.6 ml/kgw, p=0.03). In multivariate logistic regression, tidal volume was identified as the significant and independent predictive factor for survival (odds ratio 0.65, 95% confidence interval 0.44-0.95, p=0.03). Conclusions: In this study on patients with ARDS and underlying chronic respiratory diseases, the hospital mortality rate was relatively high. Lower tidal volume was identified as the significant and independent predictive factor for hospital survival.

關鍵字

chronic respiratory disease ； acute respiratory distress syndrome ； outcome ； low tidal volume

並列摘要

背景：急性呼吸窘迫症候群的嚴重缺氧由許多因子造成。慢性肺疾乃呼吸道或肺部之慢性疾病。急性呼吸窘迫症候群的部分大型研究中慢性肺疾病患是被排除的。本篇研究中，我們針對罹患急性呼吸窘迫症候群的慢性肺疾病患，研究其存活預測因子。方法：我們回溯性蒐集2012年10月至2015年5月所有入住一醫學中心有急性呼吸窘迫症候群的慢性肺疾病患。我們記錄了臨床資訊、急性呼吸窘迫症候群嚴重度及成因、呼吸器參數和存活預後等資料。結果：本在73位有急性呼吸窘迫症候群及慢性肺疾的病患中，COPD佔47.9%。院內死亡率為67.1%（49/73）。在輕度、中度、重度急性呼吸窘迫症候群中，死亡率各為76.4%（13/17）, 58.1%（18/31）, 72%（18/25）（p=0.23）。吐氣末正壓、尖峰氣道壓力及動態驅動壓力在未存活與存活病患中並無差異，但未存活者有較高的潮氣容積（8.0 ± 1.7 ml/kgw vs. 7.2 ± 1.6 ml/kgw, p=0.03）。多因子羅吉氏迴歸分析中，只有潮氣容積為有意義且獨立的院內存活預測因子（勝算比0.65, 95%信賴區間0.44-0.95, p=0.03）。結論：本研究中，罹患急性呼吸窘迫症候群的慢性肺疾病患有很高的院內死亡率，而較低的潮氣容積是有意義且獨立的存活預測因子。

並列關鍵字

慢性肺疾 ； 急性呼吸窘迫症候群 ； 預後 ； 低潮氣容積