Análise do perfil de pacientes com síndrome do desconforto respiratório agudo internados no CTI

Abstract

Acute Respiratory Distress Syndrome (ARDS) is a common condition with high morbidity and mortality in intensive care units (ICUs), characterized by multifactorial pathophysiology and wide clinical variability. Despite advances in ventilatory and hemodynamic support, its management remains challenging, especially due to the overlap of pulmonary and extrapulmonary etiologies. The COVID-19 pandemic significantly enhanced understanding of ARDS, yet it remains a highly complex syndrome. Various studies have sought to identify distinct phenotypes and individualized care strategies. One of the most investigated approaches involves the differences between pulmonary (direct) and extrapulmonary (indirect) ARDS, given their relevance to clinical and ventilatory management. This study aimed to analyze the clinical and prognostic profiles of patients with pulmonary and extrapulmonary ARDS admitted to an ICU, comparing outcomes and strategies employed between the groups. It is a retrospective, observational, and descriptive study conducted in the ICU of HUCFF between 2022 and 2024, through the analysis of electronic medical records. A total of 94 patients diagnosed with ARDS according to the Berlin criteria were included. Of these, 66 had pulmonary ARDS and 28 had extrapulmonary ARDS. Clinical, demographic, laboratory, gasometric, and ventilatory data were collected for comparative analysis. Pulmonary ARDS was associated with higher in-hospital mortality (86.4% vs. 67.9%; p = 0.03), although the difference in ICU mortality did not reach statistical significance (p = 0.13). Patients with pulmonary ARDS were mostly admitted for clinical reasons (90.9% vs. 53.5%; p < 0.001), had worse PaO₂/FiO₂ ratios (171 vs. 221; p = 0.02), and lower dynamic lung compliance (18.8 vs. 26.7; p = 0.02). Overall ICU mortality was associated with higher SAPS 3 severity scores (84 vs. 76 points; p = 0.05), increased respiratory rate (25 vs. 22 breaths per minute; p = 0.003), lower tidal volume (360 vs. 380 mL; p = 0.03), more pronounced acidosis (pH: 7.3 vs. 7.4; p < 0.001), higher lactate levels (2.5 vs. 1.1 mmol/L; p < 0.001), and more positive fluid balance in the first 72 hours after diagnosis (2,991 vs. 955 mL; p < 0.001). These findings reinforce the importance of differentiating between pulmonary and extrapulmonary ARDS in intensive care practice, considering their distinct physiological and therapeutic implications. Furthermore, they highlight the relevance of early interventions based on objective markers such as pH, lactate, and fluid balance.