After written informed consent from the legally authorized representatives, adult patients aged 18-90 years of either gender, diagnosed with ARDS on invasive mechanical ventilation will be recruited for the study. The demographic parameters – age, gender, co-morbidities, APACHE II score, SOFA score, lung ultrasound score, and KDIGO score will be noted. On day 2 (24-48 hours) of ARDS diagnosis, the following will be noted: 1. The DRONE score of the patients based on the worst value of Driving Pressure between 24-48 hours after ARDS diagnosis. 2. The Mechanical Power (MP) of the ventilator – the highest MP recorded between 24-48 hours of ventilation will be noted. On VCV, the MP of the ventilator will be calculated as: (J/min)=0.098 * RR* Vt* (PEEP+1â„2 [P plat − PEEP]+[P peak – P plat]) MP = 0.098*RR*Vt *{Peak inspiratory pressure – 0.5 [P plateau-PEEP] On PCV, the MP of the ventilator will be calculated as: MP = 0.098*RR*Vt*{PEEP + ΔP insp}, where ΔPinsp is the pressure (cmH2O) above PEEP during pressure-controlled ventilation. 3. The serum creatinine levels will be determined from day 1, 3, 5, and the last day of ICU stay of the ARDS patient. 4. Standard of care investigations like complete blood picture, renal function tests, serum electrolytes- sodium, potassium, C-reactive protein, procalcitonin, total bilirubin, albumin and echocardiography parameters will be recorded.
5. The worst lung ultrasound score will be recorded from the 12 lung regions bilaterally and the highest renal arterial resistive index will be noted between 24-48 hours of ARDS diagnosis. 6. Need for renal replacement therapy, endotracheal, blood, urine, and pus culture reports, need for prone ventilation, and net fluid balance at 48 hours of ARDS diagnosis will be noted. 7. Days of ventilator support, ICU stay and mortality outcomes will be noted. 8. If the patient requires prone position ventilation due to severe ARDS, then the MP of the ventilator will be noted before and after the prone position ventilation sessions. Primary- Mortality at 28 days from ARDS diagnosis. Secondary- Need for RRT, non resolving AKI sub phenotype.
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