Oxygen delivery in patients with adult respiratory distress syndrome who undergo surgery. Correlation with multiple-system organ failure.

Identification of the physiologic determinants of survival in patients with adult respiratory distress syndrome (ARDS) has been largely unsuccessful. We evaluated multiple physiologic variables over the first three reversible phases of ARDS. A stepwise multivariant linear regression analysis was used to identify correctable physiologic correlates with survival. Our goal was improved survival. We found that the oxygen delivery and alveolar-arterial oxygen gradient on the third day after the diagnosis of ARDS were the two most important correctable correlates. Both eventually effected the development of multiple-system organ failure and survival. These data provide clinical evidence that optimization of both the oxygen delivery and alveolar-arterial oxygen gradient after the onset of ARDS may allow resolution of ARDS, prevent additional organ dysfunction, and improve survival.