High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation |
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Authors: | K Lewandowski R Rossaint D Pappert H Gerlach K-J Slama H Weidemann D J M Frey O Hoffmann U Keske K J Falke |
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Institution: | Klinik für An?sthesiologie und operative Intensivmedizin, Virchow-Klinikum, Medizinische Fakult?t der Humboldt-Universit?t zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany FAX: +49 (30) 450 51900, DE Abteilung für An?sthesiologie und operative Intensivmedizin, Krankenhaus Spandau, Lynarstra?e 12, D-13578 Berlin, Germany, DE Klinik für Allgemeinchirurgie und Transplantationschirurgie, Virchow-Klinikum, Medizinische Fakult?t der Humboldt-Universit?t zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany, DE Abteilung für Thoraxchirurgie, Klinik Heckeshorn, Krankenhaus Zehlendorf, Zum Heckeshorn 33, D-14109 Berlin, Germany, DE Strahlenklinik und Poliklinik, Virchow-Klinikum, Medizinische Fakult?t der Humboldt-Universit?t zu Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany, DE
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Abstract: | Objective: We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in
acute respiratory distress syndrome (ARDS). Design: Uncontrolled prospective trial. Setting: One university hospital intensive
care department. Patients and participants: 122 patients with ARDS, consecutively admitted to the ICU. Interventions: ARDS
was treated according to a criteria-defined clinical algorithm. The algorithm distinguished two main treatment groups: The
AT-sine-ECMO (advanced treatment without extracorporeal membrane oxygenation) group (n = 73) received a treatment consisting of a set of advanced non-invasive treatment options, the ECMO treatment group (n = 49) received additional extracorporeal membrane oxygenation (ECMO) using heparin-coated systems. Measurements and results:
The groups differed in both APACHE II (16 ± 5 vs 18 ± 5 points, p = 0.01) and Murray scores (3.2 ± 0.3 vs 3.4 ± 0.3 points, p = 0.0001), the duration of mechanical ventilation prior to admission (10 ± 9 vs 13 ± 9 days, p = 0.0151), and length of ICU stay in Berlin (31 ± 17 vs 50 ± 36 days, p = 0.0016). Initial PaO2/FIO2 was 86 ± 27 mm Hg in AT-sine-ECMO patients that improved to 165 ± 107 mm Hg on ICU day 1, while ECMO patients showed an
initial PaO2/FIO2 of 67 ± 28 mm Hg and improvement to 160 ± 102 mm Hg was not reached until ICU day 13. Q˙S/Q˙T was significantly higher in the ECMO-treated group and exceeded 50 % during the first 14 ICU days. The overall survival rate
in our 122 ARDS patients was 75 %. Survival rates were 89 % in the AT-sine ECMO group and 55 % in the ECMO treatment group
(p = 0.0000). Conclusions: We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high
survival rates can be achieved.
Received: 9 April 1997 Accepted: 13 May 1997 |
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Keywords: | Acute respiratory distress syndrome (ARDS) Extracorporeal membrane oxygenation (ECMO) Mechanical ventilation Survival rates Clinical algorithm |
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