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Acute Respiratory Distress Syndrome in Hospitalized Patients with Community-Acquired Pneumonia
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A1461 - Acute Respiratory Distress Syndrome in Hospitalized Patients with Community-Acquired Pneumonia
Author Block: E. Barbeta1, M. F. Monreal1, A. T. Torres1, C. Cilloniz2, A. Ceccato3; 1Hospital Clínic i Provincial de Barcelona, Barcelona, Spain, 2Hospital Clínic i Provincial de Barcelona, barcelona, Spain, 3Hospital Nacional Prof Dr Alejandro Posadas, Palomar, Argentina.
Background: The incidence of acute respiratory distress syndrome (ARDS) among patients with community-acquired pneumonia (CAP) requiring mechanical ventilation is unknown. Objectives: To assess the incidence, characteristics, etiology, risk factors, and clinical outcomes of ARDS in patients treated for CAP in an intensive care unit (ICU) compared with ventilated patients without ARDS.
Methods: We prospectively enrolled consecutive adults admitted to an ICU with CAP who received mechanical ventilation over a 20-year period. ARDS was defined using the current Berlin definition. The main outcome was 30-day mortality.
Results: Among 5,334 patients hospitalized with CAP, 930 (17%) were admitted to the ICU, and 432 required either invasive or non-invasive mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria and 307 (71%) cases did not. ARDS was present in 2% of all the hospitalized patients and 13% of all the ICU patients. Based on the baseline PaO 2/FiO 2, 59 (48%), 49 (40%), and 15 (12%) patients had mild, moderate, and severe ARDS, respectively. Streptococcus pneumoniae was the most frequent pathogen, with no significant differences in etiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous treatment with inhaled corticosteroids was independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% vs. 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.
Conclusions: ARDS occurs as a complication of CAP in 29% of ventilated patients, but is not related to the etiology or outcome.
Author Block: E. Barbeta1, M. F. Monreal1, A. T. Torres1, C. Cilloniz2, A. Ceccato3; 1Hospital Clínic i Provincial de Barcelona, Barcelona, Spain, 2Hospital Clínic i Provincial de Barcelona, barcelona, Spain, 3Hospital Nacional Prof Dr Alejandro Posadas, Palomar, Argentina.
Background: The incidence of acute respiratory distress syndrome (ARDS) among patients with community-acquired pneumonia (CAP) requiring mechanical ventilation is unknown. Objectives: To assess the incidence, characteristics, etiology, risk factors, and clinical outcomes of ARDS in patients treated for CAP in an intensive care unit (ICU) compared with ventilated patients without ARDS.
Methods: We prospectively enrolled consecutive adults admitted to an ICU with CAP who received mechanical ventilation over a 20-year period. ARDS was defined using the current Berlin definition. The main outcome was 30-day mortality.
Results: Among 5,334 patients hospitalized with CAP, 930 (17%) were admitted to the ICU, and 432 required either invasive or non-invasive mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria and 307 (71%) cases did not. ARDS was present in 2% of all the hospitalized patients and 13% of all the ICU patients. Based on the baseline PaO 2/FiO 2, 59 (48%), 49 (40%), and 15 (12%) patients had mild, moderate, and severe ARDS, respectively. Streptococcus pneumoniae was the most frequent pathogen, with no significant differences in etiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous treatment with inhaled corticosteroids was independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% vs. 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.
Conclusions: ARDS occurs as a complication of CAP in 29% of ventilated patients, but is not related to the etiology or outcome.
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