The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation
| Autor: | Jesús, Villar, Jesús, Blanco, José Manuel, Añón, Antonio, Santos-Bouza, Lluís, Blanch, Alfonso, Ambrós, Francisco, Gandía, Demetrio, Carriedo, Fernando, Mosteiro, Santiago, Basaldúa, Rosa Lidia, Fernández, Robert M, Kacmarek |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty ARDS Ventilator-Induced Lung Injury Population Critical Care and Intensive Care Medicine law.invention law Outcome Assessment Health Care medicine Humans Prospective Studies Intensive care medicine Diffuse alveolar damage education Tidal volume Aged Respiratory Distress Syndrome education.field_of_study business.industry Incidence (epidemiology) Organ dysfunction Middle Aged medicine.disease Respiration Artificial Intensive care unit Intensive Care Units Pneumonia Spain Emergency medicine Female medicine.symptom business |
| Zdroj: | Intensive Care Medicine. 37:1932-1941 |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/s00134-011-2380-4 |
| Popis: | 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 PaO(2)/FiO(2) was 114 ± 40 mmHg, mean tidal volume was 7.2 ± 1.1 ml/kg predicted body weight, mean plateau pressure was 26 ± 5 cmH(2)O, and mean positive end-expiratory pressure (PEEP) was 9.3 ± 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%. |
| Databáze: | OpenAIRE |
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