Evolution of acute respiratory failure in medical and surgical septic patients: a 5 years retrospective study

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Introduction: Acute respiratory failure (ARF)due to sepsis is a common condition in ICU that affects both medical and surgical patients and it is related to outcome. Many studies report ARF epidemiology and management in these two types of patients, but few data are available on any difference in their clinical evolution. Objectives: Compare ARF evolution in medical and surgical septic patients admitted to ICU. Methods: Septic patients admitted to our general ICU with PaO2/FiO2(P/F) ratio≤300mmHg/% and mechanically ventilated for at least 3 days were analyzed in a 5 years period (2012 to 2016)for the follow parameters:SAPS II and SOFA scores, need of vasoactive drugs and days of administration, duration of mechanical ventilation(MV), incidence of superinfection, need for tracheostomy and timing, ICU and inhospital length of stay(LOS)and outcome. Traumatic and neurological patients were excluded. ARF was defined as mild(P/F300-200mmHg/%), moderate(P/F200-100mmHg/%)and severe(P/F<100mmHg/%). A p value<0.05was considered significant. Results: 400 patients were enrolled: 253 medical and 147 surgical. Moderate ARF was prevalent in both groups, but surgical patients were older (p=0.01)and with a worst sepsis severity compared to medical ones, with a 63% of incidence of septic shock(p=0.01)and a higher number of days of vasoactive drugs(p=0.01).No differences resulted for days of MV, ICU LOS, incidence of superinfection and outcome, but surgical patients required a longer post-ICU hospitalization(p=0.01). Conclusions: In our population, ARF seems to have the same evolution for medical and surgical septic patients, even if the last ones require a longer hospitalization, maybe due to their worst sepsis.

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