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Multiple Organ System Failure and Infection in Adult Respiratory Distress Syndrome

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Grant support: in part by grant HL-23578 from the National Heart, Lung and Blood Institute, and by the General Medical Research Service of the Veterans Administration Hospital. This work was completed during Dr. Bell's tenure as a Parker B. Francis Foundation Fellow.

▸Requests for reprints should be addressed to Randall C. Bell, M.D.; Pulmonary Disease Section, IIIE, Audie L. Murphy Memorial Veterans Hospital, 7400 Merton Miner Boulevard, San Antonio, TX 78284.

San Antonio, Texas

© 1983 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1983;99(3):293-298. doi:10.7326/0003-4819-99-3-293
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Patients with the adult respiratory distress syndrome and multiple organ system failure have a high mortality rate despite extensive supportive therapy. We evaluated the role of multiple organ system failure and infection in 37 consecutive survivors of the syndrome, and 47 consecutive nonsurvivors on whom autopsies were done. Failure of the central nervous, coagulation, endocrine, gastrointestinal, and renal systems was common in all patients but was more frequent in those who died. Major infections occurred in 46 nonsurvivors and 22 survivors. All patients with bacteremia who had a clinically identified site of infection survived, whereas all patients with bacteremia without a clinically identified site of infection died. Autopsy results of the latter group showed infections requiring surgical drainage for complete therapy. Patients clinically septic but without bacteremia and without a clear site of infection were shown at autopsy to have pneumonia. Multiple organ system failure was more common in infected (93%) than noninfected (47%) patients. Vigorous evaluation and treatment of infection in patients with the adult respiratory distress syndrome may improve survival.





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