About: Management and outcomes of acute respiratory distress syndrome patients with and without comorbid conditions

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An Entity of Type : schema:ScholarlyArticle, within Data Space : wasabi.inria.fr associated with source document(s)

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type	Academic Article research paper schema:ScholarlyArticle
isDefinedBy	Covid-on-the-Web dataset
title	Management and outcomes of acute respiratory distress syndrome patients with and without comorbid conditions
Creator	Azoulay, Elie Darmon, Michael Papazian, Laurent Timsit, Jean-François Lemiale, Virginie Mourvillier, Bruno Argaud, Laurent Souweine, Bertrand Cohen, Yves Garrouste-Orgeas, Maite Kallel, Hatem Marcotte, Guillaume Reignier, Jean Ruckly, Stéphane Schwebel, Carole Siami, Shidasp
source	PMC
abstract	RATIONALE: The standard of care for patients with acute respiratory distress syndrome (ARDS) has been developed based on studies that usually excluded patients with major comorbidities. OBJECTIVES: To describe treatments and outcomes according to comorbidities in patients with ARDS admitted to 19 ICUs (1997–2014). METHODS: Patients were grouped based on comorbidities. Determinants of day-28 mortality were identified by multivariable Cox analysis stratified on center. MEASUREMENTS AND MAIN RESULTS: Among 4953 ARDS patients, 2545 (51.4%) had major comorbidities; the proportion with major comorbidities increased after 2008. Hematological malignancy was associated with severe ARDS and rescue therapies for refractory hypoxemia. COPD, HIV infection, and hematological malignancy were associated with a lower likelihood of invasive mechanical ventilation on the admission day. Admission-day SOFA score was higher in patients with major comorbidities, who more often received vasopressors, dialysis, or treatment-limitation decisions. Day-28 mortality was 33.7% overall, 27.2% in patients without major comorbidities, and 31.1% (COPD) to 56% (hematological malignancy) in patients with major comorbidities. By multivariable analysis, mortality was lower in patients with COPD and higher in those with chronic heart failure, solid tumors, or hematological malignancies. Mortality was independently associated with P(a)O(2)/F(i)O(2) and PaCO(2) on day 1, ARDS of pulmonary origin, worse SOFA score, and ICU-acquired events. CONCLUSIONS: Half the patients with ARDS had major comorbidities, which were associated with severe ARDS, multiple organ dysfunction, and day-28 mortality. These findings do not support the exclusion of ARDS patients with severe comorbidities from randomized clinical trials. Trials in ARDS patients with whatever comorbidities are warranted. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-018-5209-6) contains supplementary material, which is available to authorized users.
has issue date	2018-06-07(xsd:dateTime)
bibo:doi	10.1007/s00134-018-5209-6
bibo:pmid	29881987
has license	no-cc
sha1sum (hex)	4a5b8583e7930525970ed9c6cf284b9e883f1145
schema:url	https://doi.org/10.1007/s00134-018-5209-6
resource representing a document's title	Management and outcomes of acute respiratory distress syndrome patients with and without comorbid conditions
has PubMed Central identifier	PMC7095161
has PubMed identifier	29881987
schema:publication	Intensive Care Med
resource representing a document's body	covid:4a5b8583e7930525970ed9c6cf284b9e883f1145#body_text
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