Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Quyen Bach, Mercer University College of Pharmacy

 

Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury associated with increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue. [1]

It is stated that there is limited information about the epidemiology, recognition, management, and outcomes of patients with ARDS [2] and that prospective studies have been limited to small numbers of centers and patients. [3]

Epidemiology, Patterns of Care, and Mortality for Patients with Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries [4]
Design International, multicenter, prospective cohort; N = 4,499
Objective To determine the intensive care unit (ICU) epidemiology and outcomes from acute respiratory distress syndrome (ADRS), and to understand how clinicians use mechanical ventilation and adjunctive interventions in routine clinical practice
Study Groups N/A
Methods Patients were evaluated daily for acute hypoxemic respiratory failure, defined as the concurrent presence of (1) the ratio of arterial oxygen tension to inspired fraction of oxygen (PaO2/FIO2) of 300 mmHg or less, (2) new pulmonary parenchymal abnormalities on chest x-ray or computed tomography, and (3) ventilator support with continuous positive airway pressure (CPAP), expiratory positive airway pressure (EPAP), or positive end-expiratory pressure (PEEP) of 5 cm H2O or more.
Duration 90 days
Primary Outcome Measure ICU incidence of ARDS
Baseline Characteristics Parameter Value 95% CI
Mean age, yr 61.5 60.9-62.1
Women, no.(%) 1,151 (38)  
Chronic disease, no. (%)    
COPD 657 (21.7)  
Diabetes 657 (21.7)  
Immunoincompetence 365 (12.1)  
Chronic cardiac failure 314 (10.4)  
Chronic renal failure 306 (10.1)  
Active neoplasm 258 (8.5)  
Hematological disease 142 (4.7)  
Risk factor for ARDS, no. (%)    
Pneumonia 1,794 (59.4)  
Extrapulmonary sepsis 484 (16.0)  
Aspiration 430 (14.2)  
Noncardiogenic shock 226 (7.5)  
Duration of invasive mechanical ventilation, median, d 8  
Duration of ICU stay, median, d 10  
ICU survival, no. (%) 1,994 (66) 64.3-67.7
Duration of hospital stay, median, d 17  
Hospital survival, no. (%) 1,826 (60.4) 58.7-62.2
Results Parameter Value, no. (%) 95% CI
ARDS 3,022 (10.4) 10.0-10.7
ARDS in first 48h after acute hypoxemic respiratory failure 2,813  
No longer fulfill ARDS criteria after 24h 486 (17) 15.9-18.7
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be under-recognized, undertreated, and associated with a high mortality rate.

Since it was conducted at 459 ICUs in 50 countries on 5 continents, this study showed that ARDS appears to represent an important public health problem globally. One of the study’s limitations was that it was carried out during winter months, which may overestimate ICU incidence figures for ARDS due to season-specific diseases such as influenza. Future studies are warranted to examine the burden of ARDS during different seasons across the globe.

References

  1. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-33.
  2. Brun-buisson C, Minelli C, Bertolini G, et al. Epidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study. Intensive Care Med. 2004;30(1):51-61.
  3. Hernu R, Wallet F, Thiollière F, et al. An attempt to validate the modification of the American-European consensus definition of acute lung injury/acute respiratory distress syndrome by the Berlin definition in a university hospital. Intensive Care Med. 2013;39(12):2161-70.
  4. Bellani G, Laffey JG, Pham T, et al. Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA. 2016;315(8):788-800.
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