Risk factors for the development of acute respiratory distress syndrome: a case-control study

Abstract

Introduction: The acute respiratory distress syndrome (ARDS) is an important cause of acute respiratory failure, is associated with a significant risk of mortality; despite current progress in mechanical ventilation and protective lung ventilation. Determine risk factors for the development of ARDS in children with more than 48 hours of mechanical ventilation. Objective: Determine risk factors for the development of ARDS in children with more than 48 hours of mechanical ventilation. Materials and Methods: Was designed a case-control study, where were compared 61 children with ARDS with 183 controls without ARDS with age between 1 month and 15 years. A logistic regression model was created to evaluate the effect on the risk. Results: In univariate analysis, the factors associated with ARDS were: PELOD score, pulmonary contusion, multiple trauma, shock, red blood cell transfusion, fluid overload, PaO2/FiO(2) ratio, oxygenation index, PEEP and 2 2pH. Through binary logistic regression was identified as predictors for the development of ARDS: More than 3 red blood cell transfusions (OR: 1.5; 95% CI 1.2 -1.9, p = 0.010), fluid overload (OR: 1.3; 95% CI 1.1 -5.7, p = 0.012) and oxygenation index more than 8 without other criteria for ARDS (OR: 1.9; 95% CI 1.4 -2.6, p < 0.0001). Mortality was higher in the group with ARDS (37.7% vs. 6.0%, p < 0.0001). Conclusion: More than 3 red blood cell transfusions, fluid overload and oxygenation index more than 8 are risk factors for the development of ARDS. Early recognition of risk factors of ARDS could help decrease its development.