Incidence and outcomes of acute respiratory distress syndrome in intensive care units of mainland China: a multicentre prospective longitudinal study
Incidence and outcomes of acute respiratory distress syndrome in intensive care units of mainland China: a multicentre prospective longitudinal study
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DOI：
10.1186/s13054-020-03112-0
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发表时间：
2020-08-20
期刊：
影响因子：
15.1
通讯作者：
Zhan, Qingyuan
中科院分区：
文献类型：
--
作者：
Huang, Xu;Zhang, Ruoyang;Zhan, Qingyuan
目的：评价内科/呼吸重症监护病房（MICU/RICU）中急性呼吸窘迫综合征（ARDS）的发病率和死亡率，以评估符合柏林ARDS定义的中国大陆患者在常规临床实践中的通气管理和辅助治疗的使用。纳入符合柏林ARDS定义的患者。基线数据和呼吸机管理和使用辅助治疗的数据进行了collected.Results：在18,793例患者入院参加ICU在研究的时间范围内，672例患者符合柏林ARDS标准和527例患者被纳入分析。在402例（77.0）患者中，最常见的ARDS诱发因素是肺炎。轻、中、重度ARDS的患病率分别为9.7%（51/527）、47.4%（250/527）和42.9%（226/527）。总共有400例（75.9%）患者在ICU住院期间接受有创机械通气治疗。所有ARDS患者的潮气量为6.8（5.8-7.9）mL/kg体重，呼气末正压（PEEP）为8（6-12）cmH 2 O。分别在61例（15.3%）和85例（16.1%）通气患者中使用了复张动作（RM）和俯卧位。92例（17.5%）患者停止生命维持治疗。死亡率分析结果显示，244例（46.3%）急性呼吸窘迫综合征患者（16例（31.4%）为轻度，101例（40.4%）为中度，127例（56.2%）为重度。死亡率和停止维持生命护理的比率很高。遵循推荐的肺保护策略，具有高度的依从性，但缺乏辅助治疗的实施。这些结果表明，在中国的ARDS患者的管理改进的潜力。
Objectives: To evaluate the incidence and mortality of acute respiratory distress syndrome (ARDS) in medical/respiratory intensive care units (MICUs/RICUs) to assess ventilation management and the use of adjunct therapy in routine clinical practice for patients fulfilling the Berlin definition of ARDS in mainland China.Methods: This was a multicentre prospective longitudinal study. Patients who met the Berlin definition of ARDS were included. Baseline data and data on ventilator management and the use of adjunct therapy were collected.Results: Of the 18,793 patients admitted to participating ICUs during the study timeframe, 672 patients fulfilled the Berlin ARDS criteria and 527 patients were included in the analysis. The most common predisposing factor for ARDS in 402 (77.0) patients was pneumonia. The prevalence rates were 9.7% (51/527) for mild ARDS, 47.4% (250/527) for moderate ARDS, and 42.9% (226/527) for severe ARDS. In total, 400 (75.9%) patients were managed with invasive mechanical ventilation during their ICU stays. All ARDS patients received a tidal volume of 6.8 (5.8-7.9) mL/kg of their predicted body weight and a positive end-expository pressure (PEEP) of 8 (6-12) cmH(2)O. Recruitment manoeuvres (RMs) and prone positioning were used in 61 (15.3%) and 85 (16.1%) ventilated patients, respectively. Life-sustaining care was withdrawn from 92 (17.5%) patients. When these patients were included in the mortality analysis, 244 (46.3%) ARDS patients (16 (31.4%) with mild ARDS, 101 (40.4%) with moderate ARDS, and 127 (56.2%) with severe ARDS) died in the hospital.Conclusions: Among the 18 ICUs in mainland China, the incidence of ARDS was low. The rates of mortality and withdrawal of life-sustaining care were high. The recommended lung protective strategy was followed with a high degree of compliance, but the implementation of adjunct treatment was lacking. These findings indicate the potential for improvement in the management of patients with ARDS in China.