Survival of patients with lung failure depends on health of other organs

Doctors treating lung failure need to focus on the whole patient to improve the chance of patient survival. Research published on 9th July in Critical Care shows that the survival rate of patients admitted to hospital with lung failure alone is good, but diminishes if other vital organs fail.

Hans Flaatten and colleagues carried out the 30-month study on intensive care unit (ICU) patients at the Haukeland University Hospital, Norway. They followed 529 patients diagnosed with acute respiratory failure (ARF) and measured their outcome in relation to the presence or absence of failure of other vital organs. They found that the mortality rate of patients with ARF alone was surprisingly low, but that it increased with each additional organ failure. Patients who were admitted with ARF alone had a mortality rate of 4.4% at ICU discharge, but this jumped to 33.3% if they were suffering from any additional organ failure at admission.

ICU patients diagnosed with ARF were followed up at three intervals after initial diagnosis – discharge from the intensive care unit, discharge from hospital, and 90 days after initial diagnosis. Patients who were suffering from ARF alone had a mortality rate of only 3.2% at ICU discharge, and rates of 14.7% and 21.8% at hospital discharge and at 90 days, respectively. The failure of only one other vital organ approximately doubled the mortality rates to 11.6%, 28.5% and 43.6%, respectively. When ARF was associated with the failure of four or five vital organs, the three-month mortality rate was as high as 75%.

ARF is the most common type of organ failure seen in the ICU; multiple organ failure is the most common cause of death in ICU patients. Dr. Flaatten said, “It is very important to have the whole patient in focus when treating ARF. Other organ failure is frequent, and needs to be diagnosed and treated if the patient is to have the maximal chance of survival. It is also possible to estimate the chance of survival on the number of organs that have failed. If the patients only have ARF the short and long-term prognosis is quite good.”

Arthur Slutsky, research editor for Critical Care and Director of the Interdepartmental Division of Critical Care at the University of Toronto, believes that, “This study demonstrates that in patients with ARF, dysfunction of organs other than the lung is a major contributor to mortality. It emphasizes how critical it is to focus therapy not only on the lung, but also on maintenance in other vital organ function”.

This research will prove invaluable in assessing the prognosis of patients with ARF and provides food for thought for doctors treating patients with multiple organ failure.