Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients
Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients
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DOI：
10.1007/s001340050983
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发表时间：
1999-09-01
影响因子：
38.9
通讯作者：
Brochard, L
中科院分区：
文献类型：
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作者：
Roupie, E;Lepage, E;Brochard, L
目的：评价急性呼吸窘迫综合征（ARDS）在需要机械通气患者中的患病率和转归。设计：一项前瞻性、多机构、初始队列研究，包括28天随访。设置：来自法国重症监护协会（SRLF）工作组的36个法国重症监护病房（ICU）。患者：对14天内进入ICU的所有患者进行前瞻性筛选。低氧血症患者定义为PaO 2/FIO 2比值（P/F）≤ 300 mmHg并接受机械通气，根据ARDS共识会议将其分为三组：第1组指ARDS（P/F：200 mmHg或更低，胸部X线显示双侧浸润）;第2组为急性肺损伤（ALI），无ARDS标准（200 < P/F < 300 mmHg和双侧浸润）和第3组为P/F为300 mmHg或更低但符合前一组排除标准的患者。在研究期间，976例患者进入ICU，其中43%接受机械通气，213例（22%）符合三组之一的标准。在所有入住ICU的患者中，ARDS、ALI和第3组患者分别占6.9%（67）、1.8%（17）和13.3%（129），占低氧血症、通气患者的31.5%、8.1%和60.2%。总死亡率为41%，其中ARDS患者的死亡率明显高于其他患者（60%vs31%p < 0.01）。在第3组中，42名患者的P/F小于200 mmHg，与单侧肺损伤相关;死亡率（40.5%）显著低于ARDS组。在整个组的低氧血症，通气患者，感染性休克和严重程度指数，但没有氧合指数与死亡率显着相关，而与免疫抑制的关联显示只有一个趋势（p = 0.06）。结论：在这项调查中，我们发现，很少有患者符合急性肺损伤非ARDS的标准，并与ARDS组的死亡率很高。
Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation.Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up.Settings: Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF).Patients: All the patients entering the ICUs during a 14-day period were screened prospectively. Hypoxemic patients, defined as having a PaO2/FIO2 ratio (P/F) of 300 mmHg or less and receiving mechanical ventilation, were classified into three groups, according to the Consensus Conference on ARDS: group 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on the chest X-ray); group 2 to acute lung injury (ALI) without having criteria for ARDS (200 < P/F < 300 mmHg and bilateral infiltrates) and group 3 to patients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups.Results: Nine hundred seventy-six patients entered the ICUs during the study period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, ARDS, ALI and group 3 patients amounted, respectively, to 6.9% (67), 1.8% (17) and 13.3 % (129) of the patients, and represented 31.5%, 8.1% and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41% and was significantly higher in ARDS patients than in the others (60 % vs 31 % p < 0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury; mortality was significantly lower (40.5 %) than in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were significantly associated with mortality, while the association with immunosuppression revealed only a trend (p = 0.06).Conclusions: In this survey we found that very few patients fulfilled the ALI non-ARDS criteria and that the mortality of the group with ARDS was high.