Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units: a comparison of two large cohorts

Critical Care

Luis E. Fontes¹  Yasser Sakr²  Miguel de Melo Gurgel²  Katarzyna Kotfis³  Thais Midega⁴  Xavier Wittebole⁵  Stephan M. Jakob⁶  Jean-Louis Vincent⁷  Jordi Solé-Violan⁸  V. Marco Ranieri⁹  Bruno François^1,10  Angel Estella^1,11  Ulrich Jaschinski^1,12  Marc Leone^1,13 

[1] Departamento de Medicina Baseada em Evidências, Medicina Intensiva, Urgência e Emergência - Faculdade de Medicina de Petrópolis, Petrópolis, Brazil;Department of Anaesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany;Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland;Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil;Department of Critical Care, Cliniques Universitaires St Luc, UCLouvain, Brussels, Belgium;Department of Intensive Care Medicine, University Hospital Bern, University of Bern, Bern, Switzerland;Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium;Department of Intensive Care, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain;Department of Medical and Surgical Science, Anesthesia and Intensive Care, Policlinico di Sant’Orsola, Alma Mater, University of Bologna, Bologna, Italy;Intensive Care Unit and Inserm CIC 1435 & UMR 1092, Dupuytren University Hospital, Limoges, France;Intensive Care Unit, Hospital SAS Jerez, Jerez, Spain;Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinik Augsburg, Universität Augsburg, Augsburg, Germany;Service d’Anesthésie et de Réanimation, APHM, Hôpital Nord, Aix Marseille Université, Marseille, France;

关键词: Respiratory failure;    ARDS;    Airway pressures;    Driving pressure;    Tidal volume;    Mechanical ventilation;   

DOI  :  10.1186/s13054-020-03455-8

来源: Springer

【 摘 要 】

BackgroundMortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients.MethodsThis was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days.ResultsThe frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death.ConclusionThe frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.

【 授权许可】

CC BY