The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation
The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation
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DOI：
10.1007/s00134-011-2380-4
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发表时间：
2011-12-01
影响因子：
38.9
通讯作者：
Kacmarek, Robert M.
中科院分区：
文献类型：
--
作者：
Villar, Jesus;Blanco, Jesus;Kacmarek, Robert M.
尽管我们对急性呼吸窘迫综合征（ARDS）的发病机制和治疗的了解在过去十年中有所提高，但对其发病率的估计一直存在争议。本研究的目的是检查 ARDS 诊断前后在当前肺保护性通气支持实践下的 ARDS 发生率和结果。这是一项 2008 年 11 月至 2009 年 10 月期间在西班牙 13 个地理区域（服务于 355 万至少 18 岁人口）为期 1 年的前瞻性、多中心、观察性研究。受试者包括符合美国-欧洲 ARDS 共识标准的所有连续患者。收集了有关通气管理、气体交换、血流动力学和器官功能障碍的数据。共有 255 名机械通气患者符合 ARDS 定义，发病率为 7.2/100,000 人/年。肺炎和败血症是 ARDS 的最常见原因。达到 ARDS 标准时，平均 PaO2/FiO(2) 为 114 +/- A 40 mmHg，平均潮气量为 7.2 +/- A 1.1 ml/kg 预测体重，平均平台压为 26 +/- A 5 cmH(2)O，平均呼气末正压 (PEEP) 为 9.3 +/- A 2.4 cmH(2)O。重症监护病房 (ICU) 和医院总体 ARDS 死亡率分别为 42.7% (95% CI 37.7-47.8) 和 47.8% (95% CI 42.8-53.0)。这是第一项前瞻性评估常规应用肺保护性通气期间 ARDS 发生率的研究。我们的研究结果支持了欧洲之前的估计，并且比美国和澳大利亚报告的结果低一个数量级。尽管使用肺保护性通气，ARDS患者的整体ICU和医院死亡率仍高于40%。
While our understanding of the pathogenesis and management of acute respiratory distress syndrome (ARDS) has improved over the past decade, estimates of its incidence have been controversial. The goal of this study was to examine ARDS incidence and outcome under current lung protective ventilatory support practices before and after the diagnosis of ARDS.This was a 1-year prospective, multicenter, observational study in 13 geographical areas of Spain (serving a population of 3.55 million at least 18 years of age) between November 2008 and October 2009. Subjects comprised all consecutive patients meeting American-European Consensus Criteria for ARDS. Data on ventilatory management, gas exchange, hemodynamics, and organ dysfunction were collected.A total of 255 mechanically ventilated patients fulfilled the ARDS definition, representing an incidence of 7.2/100,000 population/year. Pneumonia and sepsis were the most common causes of ARDS. At the time of meeting ARDS criteria, mean PaO2/FiO(2) was 114 +/- A 40 mmHg, mean tidal volume was 7.2 +/- A 1.1 ml/kg predicted body weight, mean plateau pressure was 26 +/- A 5 cmH(2)O, and mean positive end-expiratory pressure (PEEP) was 9.3 +/- A 2.4 cmH(2)O. Overall ARDS intensive care unit (ICU) and hospital mortality was 42.7% (95%CI 37.7-47.8) and 47.8% (95%CI 42.8-53.0), respectively.This is the first study to prospectively estimate the ARDS incidence during the routine application of lung protective ventilation. Our findings support previous estimates in Europe and are an order of magnitude lower than those reported in the USA and Australia. Despite use of lung protective ventilation, overall ICU and hospital mortality of ARDS patients is still higher than 40%.