[Source: The Journal of the American Medical Association, full page: (LINK). Abstract, edited.]
Original Investigation | February 23, 2016 | Caring for the Critically Ill Patient
Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries [ ]
Giacomo Bellani, MD, PhD1,2; John G. Laffey, MD, MA3,4; Tài Pham, MD5,6,7; Eddy Fan, MD, PhD8,9; Laurent Brochard, MD, HDR10,11; Andres Esteban, MD, PhD12; Luciano Gattinoni, MD, FRCP13; Frank van Haren, MD, PhD14; Anders Larsson, MD, PhD15; Daniel F. McAuley, MD, PhD16,17,18; Marco Ranieri, MD19; Gordon Rubenfeld, MD, MSc20,21; B. Taylor Thompson, MD, PhD22; Hermann Wrigge, MD, PhD23; Arthur S. Slutsky, MD, MASc24; Antonio Pesenti, MD13 ; for the LUNG SAFE Investigators and the ESICM Trials Group
Author Affiliations: 1School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy 2Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy 3Departments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael’s Hospital 4Departments of Anesthesia, Physiology and Interdepartmental division of Critical Care Medicine, University of Toronto, Canada 5AP-HP, Hôpital Tenon, Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Groupe hospitalier des Hôpitaux Universitaires de l’Est Parisien, Paris, France 6UMR 1153, Inserm, Sorbonne Paris Cité, ECSTRA Team, Université Paris Diderot, Paris, France 7UMR 915, Inserm, Université Paris Est Créteil, Créteil, France 8Department of Medicine, University Health Network and Mount Sinai Hospital 9Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada 10Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Canada 11Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada 12Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain 13Istituto di Anestesia e Rianimazione, Università degli Studi di Milano, Ospedale Maggiore, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy 14Intensive Care Unit, Canberra Hospital, and Australian National University, Canberra, Australia 15Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden 16Centre for Experimental Medicine, Queen’s University of Belfast, Belfast, Northern Ireland 17Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland 18Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland 19SAPIENZA Università di ROMA, Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Viale del Policlinico 155, 00161 Roma, Italy 20Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
21Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada 22Division of Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 23Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Liebigstr. 20, D-04103 Leipzig, Germany 24Keenan Research Center at the Li Ka Shing Knowledge Institute of St Michael’s Hospital, the Interdepartmental Division of Critical Care Medicine, and the Department of Medicine, University of Toronto, Toronto, Canada
JAMA. 2016;315(8):788-800. doi:10.1001/jama.2016.0291. Published online
Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).
To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.
Design, Setting, and Participants
The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.
Acute respiratory distress syndrome.
Main Outcomes and Measures
The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.
Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.
Conclusions and Relevance
Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.
Trial Registration clinicaltrials.gov Identifier: NCT02010073
Keywords: Research; Abstracts; ARDS.