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The article investigates if there are differences in mortality from extrapulmonary and pulmonary adult respiratory distress syndrome (ARDS). Research findings show that there is no significant difference in mortality from pulmonary and extrapulmonary ARDS. It is also recommended that future research studies focus on specific etiologies within subgroups.

The article highlights a study that aims to define the prevalence, severity, and progression of non-pulmonary organ dysfunction and its effect on outcome in patients with acute respiratory failure (ARF) at the respiratory intensive care unit of a tertiary referral hospital in India. Daily patient data were collected on adult patient with ARF to calculate component and total non-pulmonary sequential organ failure assessment scores. The patient hospital survival was the main outcome measure.

Objective: Acute respiratory distress syndrome (ARDS) is an important cause of morbidity and mortality in intensive care units. Tuberculosis (TB) commonly causes respiratory failure in patients with extensive pulmonary parenchymal involvement, but it is a rare cause of ARDS. We report our experience of TB presenting with ARDS.Methods: Retrospective analysis of 187 patients admitted with a diagnosis of ARDS over the previous 7 years. Data are presented in a descriptive fashion using mean+/-SD or median (range).Results: Nine (4.9%) of 187 patients had ARDS secondary to tuberculosis. All patients were mechanically ventilated. The diagnosis was made on clinico-radiological grounds and confirmed later using fiberoptic bronchoscopy and transbronchial biopsy in seven patients, and lymph node biopsy and examination of the joint aspirate in the remaining two. All patients were empirically started on anti-tubercular therapy with a median time to initiation of therapy being 3 days (range 2-8 days). Three patients had multi-organ dysfunction syndrome (MODS) without any evidence of bacterial infection. Seven of nine (77.8%) patients survived; two died because of severe ARDS, MODS, and respiratory failure.Conclusions: Tuberculosis is an uncommon but definite cause of ARDS, and in patients with ARDS of obscure aetiology where the clinical features suggest tuberculosis as the inciting cause, antitubercular therapy should be started empirically and the diagnosis actively pursued later. [ABSTRACT FROM AUTHOR]

Objectives: Information on the spectrum and outcome of acute respiratory distress syndrome (ARDS) in tropical countries is scanty. This study was designed to assess the factors predicting the outcome of ARDS in North India. Methodology: Consecutive patients requiring mechanical ventilation for ARDS over a 2 year period at the Respiratory Intensive Care Unit (RICU) of a tertiary referral hospital were studied. Hospital survival was correlated with age, aetiology, disease severity scores (APACHE III, SAPS II, lung injury score) and organ failure using univariate analysis. Factors significantly influencing mortality were examined by multivariate analysis to identify factors independently affecting outcome. Results: Sepsis (28.6%), followed by malaria (21.4%), were the commonest risk factors. Seven out of eight patients (87.5%) with sepsis died. The presence of sepsis, more than three organ failure prior to admission, APACHE III score > 57 and SAPS II score > 39 were significantly associated with mortality. Only APACHE III score > 57 or SAPS II score > 39 were, however, independently predictive of a poor outcome following multivariate analysis. Conclusions: Sepsis, associated with a very poor outcome, and malaria were important risk factors for the development of ARDS. APACHE III score > 57 or SAPS II score > 39 were associated with increased risk of mortality. [ABSTRACT FROM AUTHOR]

A response by Ashutosh N. Aggarwal and his colleagues to a letter to the editor about their article "Nonpulmonary organ dysfunction and its impact on outcome in patients with acute respiratory failure" in a previous issue in 2007 is presented.