Scholarly Article
INTERVENTIONS, COMPLICATIONS AND ICU COURSE AS PREDICTORS OF OUTCOME IN ACUTE RESPIRATORY DISTRESS SYNDROME: A PROSPECTIVE OBSERVATIONAL STUDY
Hakim Baset, K, Harika, Mithun N. Kagalkar
2026-06-30 · International Journal of Clinical and Biomedical Research · Sumathi Publications
Abstract
Background: Patients with acute respiratory distress syndrome (ARDS) frequently require organ support and develop intensive care unit (ICU)-acquired complications. How these relate to severity and mortality is less well described in Indian cohorts. Methods: In this prospective observational study in the medical ICU of a tertiary care hospital, 100 patients fulfilling the Berlin definition of ARDS were enrolled. Acute kidney injury (AKI), renal replacement therapy (RRT), non-invasive (NIV) and invasive ventilation, tracheostomy, ventilator-associated pneumonia (VAP), transfusion and ICU length of stay were related to Berlin severity and in-hospital outcome using Fisher's exact test. Results: In-hospital mortality was 27%. AKI occurred in 70 patients and was associated with death (34.3% versus 10.0%; odds ratio [OR] 4.63, 95% confidence interval [CI] 1.23-26.28; p=0.014); RRT, required by 8, carried a steeper risk (75.0% versus 22.8%; OR 9.85; p=0.005). Invasive ventilation (33 patients) was strongly associated with death (63.6% versus 9.0%; OR 17.07; p<0.001), as was tracheostomy (82.4% versus 15.7%; OR 23.92; p<0.001). Patients managed with NIV alone had lower mortality (10.2% versus 43.1%; OR 0.15, 95% CI 0.04-0.47; p<0.001). Neither VAP (23.5% versus 27.7%; OR 0.80; p=1.00) nor transfusion (OR 2.19; p=0.113) was associated with mortality. No patient with mild ARDS required RRT, invasive ventilation or tracheostomy, or developed VAP. Mean ICU stay rose from 9.3 to 17 days. Conclusion: The depth of organ failure requiring active support, rather than the underlying complication, most sharply distinguished non-survivors. VAP showed no mortality association, most plausibly because it can only arise in patients surviving 48 hours of ventilation.
Keywords
ARDS, Mechanical ventilation, Acute kidney injury, Tracheostomy, Ventilator associated pneumonia, ICU length of stay, Mortality
Citation Details
International Journal of Clinical and Biomedical Research, Vol. 11, No. 2, pp. 250-257