Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study
Causes and characteristics of death in patients with acute hypoxemic respiratory failure and acute respiratory distress syndrome: a retrospective cohort study
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DOI：
10.1186/s13054-020-03108-w
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发表时间：
2020-07-03
期刊：
影响因子：
15.1
通讯作者：
Sjoding, Michael W.
中科院分区：
文献类型：
--
作者：
Ketcham, Scott W.;Sedhai, Yub Raj;Sjoding, Michael W.
背景 急性低氧性呼吸衰竭（AHRF）和急性呼吸窘迫综合征（ARDS）与高院内死亡率相关。然而，在 20 世纪 90 年代的 ARDS 患者队列中，患者更常见的是死于败血症或多器官衰竭，而不是难治性低氧血症。鉴于过去 25 年人们对肺保护性通气和脓毒症治疗的关注日益增加，我们假设当代人群的死因可能有所不同。这些差异可能会让临床医生深入了解未来治疗干预的目标。方法 我们确定了在单一三级护理中心（2016-2017 年）住院且患有 AHRF（定义为 PaO2/FiO(2) 12 小时）的成年患者，这些患者在住院期间死亡。 ARDS 由多名医生使用柏林定义进行判定。对 ARDS 状态不知情的独立提取者使用标准化工具收集有关器官功能障碍和生命支持撤回的数据。主要原因死亡被定义为最直接导致死亡或停止生命支持的器官系统。结果 我们确定了 385 名患有 AHRF 的死者，其中 127 名 (33%) 患有 ARDS。最常见的主要死亡原因是脓毒症（26%）、肺功能障碍（22%）和神经功能障碍（19%）。 70% 的患者在死亡时出现多器官衰竭，最常见的原因是败血症（占所有患者的 50%），70% 的患者在死亡时需要大量呼吸支持。只有 2% 的患者出现无法忍受的氧合或通气。百分之八十五的人在停止生命支持后死亡。 ARDS 患者更常以肺功能障碍作为主要死因（28% vs 19%；p = 0.04），并且在需要大量呼吸支持时死亡的可能性也更大（82% vs 64%；p < 0.01）。结论 在当代 AHRF 患者队列中，最常见的主要原因死亡是脓毒症和肺功能障碍，但很少有患者出现无法支持的氧合或通气。绝大多数死亡发生在停止生命支持后。与没有 ARDS 的患者相比，ARDS 患者更有可能以肺功能障碍为主要死因，并且在需要大量呼吸支持时死亡。
Background Acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) are associated with high in-hospital mortality. However, in cohorts of ARDS patients from the 1990s, patients more commonly died from sepsis or multi-organ failure rather than refractory hypoxemia. Given increased attention to lung-protective ventilation and sepsis treatment in the past 25 years, we hypothesized that causes of death may be different among contemporary cohorts. These differences may provide clinicians with insight into targets for future therapeutic interventions. Methods We identified adult patients hospitalized at a single tertiary care center (2016-2017) with AHRF, defined as PaO2/FiO(2) 12 h, who died during hospitalization. ARDS was adjudicated by multiple physicians using the Berlin definition. Separate abstractors blinded to ARDS status collected data on organ dysfunction and withdrawal of life support using a standardized tool. The primary cause of death was defined as the organ system that most directly contributed to death or withdrawal of life support. Results We identified 385 decedents with AHRF, of whom 127 (33%) had ARDS. The most common primary causes of death were sepsis (26%), pulmonary dysfunction (22%), and neurologic dysfunction (19%). Multi-organ failure was present in 70% at time of death, most commonly due to sepsis (50% of all patients), and 70% were on significant respiratory support at the time of death. Only 2% of patients had insupportable oxygenation or ventilation. Eighty-five percent died following withdrawal of life support. Patients with ARDS more often had pulmonary dysfunction as the primary cause of death (28% vs 19%;p = 0.04) and were also more likely to die while requiring significant respiratory support (82% vs 64%;p < 0.01). Conclusions In this contemporary cohort of patients with AHRF, the most common primary causes of death were sepsis and pulmonary dysfunction, but few patients had insupportable oxygenation or ventilation. The vast majority of deaths occurred after withdrawal of life support. ARDS patients were more likely to have pulmonary dysfunction as the primary cause of death and die while requiring significant respiratory support compared to patients without ARDS.