Incidence and outcomes of acute respiratory distress syndrome in intensive care units of mainland China: a multicentre prospective longitudinal study
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Published:2020-08-20
Issue:1
Volume:24
Page:
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ISSN:1364-8535
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Container-title:Critical Care
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language:en
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Short-container-title:Crit Care
Author:
Huang Xu, Zhang Ruoyang, Fan Guohui, Wu Dawei, Lu Haining, Wang Daoxin, Deng Wang, Sun Tongwen, Xing Lihua, Liu Shaohua, Wang Shilei, Cai Ying, Tian Ye, Zhang Yi, Xia Jingen, Zhan QingyuanORCID, Xie Lixin, Wang Ying, Weng Li, Zhu Guangfa, Liu Yan, Song Man, Zhao Yanming, Chen Jing, Zhao Hongwen, Hou Haijia, Yang Jingping, Wu Rina, Xu Xiyuan, Yan Xixin, Xu Haibo, Wu Dawei, Lu Haining, Sun Gengyun, Zhang Dan, Zhao Beilei, Pan Binhai, Liu Jialin, Tan Ruoming, Pan Pinhua, Lu Rongli, Luo Hong, Zhang Han, Wang Daoxin, Deng Wang, Chen Yusheng, Lu Fengfeng, Xu Sicheng, Luo Xia, Teng Hong, Chen Lijuan, Xing Lihua, Wang Shilei, Sun Tongwen, Liu Shaohua, Han Bing, Li Yunlu,
Abstract
Abstract
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) cmH2O. 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.
Trial registration
Clinicaltrials.gov NCT02975908. Registered on 29 November 2016—retrospectively registered.
Funder
Beijing Municipal Science and Technology Project CAMS Innovation Fund for Medical Sciences
Publisher
Springer Science and Business Media LLC
Subject
Critical Care and Intensive Care Medicine
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