Epidemiology of acute hypoxaemic respiratory failure in Australian and New Zealand intensive care units during 2005-2022. A binational, registry-based study.

Autor: Ling RR; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. ryan.ling@u.nus.edu.; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. ryan.ling@u.nus.edu.; Department of Anaesthesia, National University Hospital, National University Health System, Singapore, Singapore. ryan.ling@u.nus.edu., Ponnapa Reddy M; Department of Anaesthesia and Pain Medicine, Nepean Hospital, Sydney, Australia.; Department of Intensive Care Medicine, North Canberra Hospital, Canberra, ACT, Australia.; Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia., Subramaniam A; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care Medicine, Peninsula Health, Frankston, VIC, Australia.; Department of Intensive Care Medicine, Dandenong Hospital, Monash Health, Dandenong, VIC, Australia.; Peninsula Clinical School, Monash University, Frankston, VIC, Australia., Moran B; Department of Intensive Care Medicine, Gosford Hospital, Gosford, NSW, Australia.; Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, NSW, Australia.; University of Newcastle, Callaghan, NSW, Australia., Ramanathan K; Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.; Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore., Ramanan M; Intensive Care Unit, Caboolture Hospital, Brisbane, QLD, Australia.; School of Medicine, Mayne Academy of Critical Care, The University of Queensland, St Lucia, QLD, Australia.; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.; Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia., Burrell A; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia., Pilcher D; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.; Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia., Shekar K; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.; Bond University, Gold Coast, QLD, Australia.; Faculty of Health, Queensland University of Technology, Brisbane, Australia.; University of Queensland, Brisbane, QLD, Australia.
Jazyk: angličtina
Zdroj: Intensive care medicine [Intensive Care Med] 2024 Nov; Vol. 50 (11), pp. 1861-1872. Date of Electronic Publication: 2024 Sep 02.
DOI: 10.1007/s00134-024-07609-y
Abstrakt: Purpose: Acute hypoxaemic respiratory failure (AHRF) is a common reason for intensive care unit (ICU) admission. However, patient characteristics, outcomes, and trends over time are unclear. We describe the epidemiology and outcomes of patients with AHRF over time.
Methods: In this binational, registry-based study from 2005 to 2022, we included all adults admitted to an Australian or New Zealand ICU with an arterial blood gas within the first 24 h of ICU stay. AHRF was defined as a partial pressure of oxygen/inspired oxygen ratio (PaO 2 /FiO 2 ) ≤ 300. The primary outcome was adjusted in-hospital mortality, categorised based on PaO 2 /FiO 2 (mild: 200-300, moderate: 100-200, and severe < 100, and non-linearly). We investigated how adjusted mortality evolved based on temporal trends (by year of admission), sex, age, admission diagnosis and the receipt of mechanical ventilation.
Results: Of 1,560,221 patients, 826,106 (52.9%) were admitted with or developed AHRF within the first 24 h of ICU stay. Of these 826,106 patients, 51.4% had mild, 39.3% had moderate, and 9.3% had severe AHRF. Compared to patients without AHRF (5.3%), patients with mild (8%), moderate (14.2%) and severe (29.9%) AHRF had higher in-hospital mortality rates. As PaO 2 /FiO 2 ratio decreased, adjusted in-hospital mortality progressively increased, particularly below an inflection point at a PaO 2 /FiO 2 ratio of 200. The adjusted in-hospital mortality for all patients decreased over time (13.3% in 2005 to 8.2% in 2022), and this trend was similar in patients with and without AHRF.
Conclusion: The healthcare burden due to AHRF may be larger than expected, and mortality rates remain high in severe AHRF. Although mortality has decreased over time, this may reflect improvements in ICU care in general, rather than specifically in AHRF. More research is required to earlier identify AHRF and stratify these patients at risk of deterioration early, and to validate our findings.
(© 2024. The Author(s).)
Databáze: MEDLINE
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