Multiple Organ System Failure and Infection in Adult Respiratory Distress Syndrome

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Abstract
The role of multiple organ system failure and infection was evaluated in 37 consecutive survivors of adult respiratory distress syndrome and 47 consecutive nonsurvivors on whom autopsies were done. Failure of the CNS, 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; all patients with bacteremia without a clinically identified infection site died. Autopsy results of the latter group showed infections requiring surgical drainage for complete therapy. Patients clinically septic, but without bacteremia or a clear infection site 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.