Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia
Acute respiratory distress syndrome in mechanically ventilated patients with community-acquired pneumonia
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DOI：
10.1183/13993003.02215-2017
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发表时间：
2018-03-01
影响因子：
24.3
通讯作者：
Torres, Antoni
中科院分区：
文献类型：
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作者：
Cilloniz, Catia;Ferrer, Miquel;Torres, Antoni
为了解重症监护病房(ICU)社区获得性肺炎(CAP)患者急性呼吸窘迫综合征(ARDS)的发生率、特点、病原学、危险因素和死亡率，采用柏林定义，对20年来连续接受机械通气的社区获得性肺炎(CAP)患者和非ARDS患者进行比较。在5334名CAP住院患者中，930人(17%)住进ICU，432人需要机械通气；125人(29%)符合柏林ARDS标准。2%的住院患者和13%的ICU患者出现ARDS。根据基础动脉血氧分压/吸氧率，轻、中、重度ARDS患者分别为60例(48%)、49例(40%)和15例(12%)。肺炎链球菌是最常见的致病菌，组间病原学差异无统计学意义。在多变量分析中，较高的器官系统功能障碍和既往使用抗生素是ARDS的独立危险因素，而既往吸入皮质类固醇与较低的风险独立相关。经倾向调整的多变量分析证实，ARDS患者和非ARDS患者的30天死亡率相似(25%比30%，p=0.25)。ARDS在29%的机械通气患者中是CAP的并发症，但与病因或死亡率无关。
Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively. Streptococcus pneumoniae was the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% versus 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.