In patients meeting the definition of acute respiratory distress syndrome (ARDS), mortality is approximately 40%. ARDS patients were more likely to have pulmonary dysfunction as the primary cause of death and die while requiring significant respiratory support compared to patients without ARDS.Īcute hypoxemic respiratory failure (AHRF) is among the most common causes of critical illness, with a hospital mortality of approximately 30%. The vast majority of deaths occurred after withdrawal of life support.
In this contemporary cohort of patients with AHRF, the most common primary causes of death were sepsis and pulmonary dysfunction, but few patients had insupportable oxygenation or ventilation. Patients with ARDS more often had pulmonary dysfunction as the primary cause of death (28% vs 19% p = 0.04) and were also more likely to die while requiring significant respiratory support (82% vs 64% p < 0.01). Eighty-five percent died following withdrawal of life support.
Only 2% of patients had insupportable oxygenation or ventilation. Multi-organ failure was present in 70% at time of death, most commonly due to sepsis (50% of all patients), and 70% were on significant respiratory support at the time of death. The most common primary causes of death were sepsis (26%), pulmonary dysfunction (22%), and neurologic dysfunction (19%).
We identified 385 decedents with AHRF, of whom 127 (33%) had ARDS. The primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. Separate abstractors blinded to ARDS status collected data on organ dysfunction and withdrawal of life support using a standardized tool. ARDS was adjudicated by multiple physicians using the Berlin definition. We identified adult patients hospitalized at a single tertiary care center (2016–2017) with AHRF, defined as PaO 2/FiO 2 ≤ 300 while receiving invasive mechanical ventilation for > 12 h, who died during hospitalization. These differences may provide clinicians with insight into targets for future therapeutic interventions. Given increased attention to lung-protective ventilation and sepsis treatment in the past 25 years, we hypothesized that causes of death may be different among contemporary cohorts. However, in cohorts of ARDS patients from the 1990s, patients more commonly died from sepsis or multi-organ failure rather than refractory hypoxemia. The evidence is not sufficient to modify current recommendations for calcium intake to protect skeletal health with respect to vascular calcification risk.Acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) are associated with high in-hospital mortality. Results were similar for dietary calcium and calcium supplement useĬONCLUSIONS: Our study does not support the hypothesis that high calcium intake increases coronary artery calcification, which is an important measure of atherosclerosis burden. Multivariable-adjusted mean Agatston scores were 2.36, 2.52, 2.16, and 2.39 (P-trend = 0.74) with an increasing quartile of total calcium intake in women and 4.32, 4.39, 4.19, and 4.37 (P-trend = 0.94) in men, respectively. RESULTS: The mean age-adjusted coronary artery-calcification Agatston score decreased with increasing total calcium intake, and the trend was not significant after adjustment for age, BMI, smoking, alcohol consumption, vitamin D-supplement use, energy intake, and, for women, menopause status and estrogen use.
Participants included 690 women and 588 men in the Framingham Offspring Study (mean age: 60 y range: 36-83 y) who attended clinic visits and completed food-frequency questionnaires in 1998-2001 and underwent computed tomography scans 4 y later in 2002-2005. OBJECTIVE: We assessed the association between calcium intake (from diet and supplements) and coronary artery calcification, which is a measure of atherosclerosis that predicts risk of ischemic heart disease independent of other risk factors.ĭESIGN: This was an observational, prospective cohort study. However, studies that have reported adverse effects of calcium supplementation on vascular events have raised widespread concern. Samelson EJ, Booth SL, Fox CS, Tucker KL, Wang TJ, Hoffmann U, Cupples LA, O'Donnell CJ, Kiel DP.īACKGROUND: Adequate calcium intake is known to protect the skeleton. Calcium intake is not associated with increased coronary artery calcification: the Framingham Study.
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