The Time Course of Acute Respiratory Failure

Despite its limited prognostic value, the degree of hypoxemia can be an important predictor of disease progression in patients with ARF. As early as 1989, Bone et al [50] emphasized that survivors and nonsurvivors differed in the early response of the PaO2/FiO2 ratio to conventional therapy. Likewise, higher degrees of organ failure are likely to be present in nonsurvivors than in survivors, as MOF is the cause of death in the majority of patients; however, the time course of organ failure can follow different patterns before reaching this final stage.

In a prospective study of 182 patients with ARF in our institution (unpublished observations), we separated 133 patients who had early ARF (an onset < 48 hours after ICU admission) and 49 with late ARF (an onset <48 hours after ICU admission). On admission, the cardiovascular SOFA score was higher in early than in late ARF, whereas the neurologic score was higher in late than in early ARF. In early ARF, a high SOFA score and low Glasgow Coma Score were predictors of mortality, and in late ARF, a low Glasgow Coma Score at 48 hours predicted mortality. These findings suggest that there may be important differences in the epidemiology and outcome of ARF that are dependent on the time of onset.

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