Jia et al identified risk factors for a patient developing the adult respiratory distress syndrome (ARDS) after receiving mechanical ventilation for > 48 hours. These factors can help identify a patient who may benefit from more aggressive management. The authors are from MIT, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center in Boston.


Patient selection: mechanical ventilation > 48 hours and without ARDS at outset


Risk factors identified on multivariate analysis:

(1) high peak airway pressure

(2) high net fluid balance (fluid overload)

(3) transfusion of fresh frozen plasma (FFP)

(4) sepsis

(5) high tidal volume


Additional factors identified on the univariate analysis:

(1) elevated serum lactate (metabolic acidosis)

(2) low serum albumin

(3) transfusion of packed RBCs

(4) low respiratory compliance

(5) increasing PEEP


NOTE: The odds ratios for these factors were all relatively low (none more than 1.6). This suggests that multiple factors must be present to be predictive.


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