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Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.

IMPORTANCELimited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVESTo evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation managemen... Full description

Journal Title: JAMA February 23, 2016, Vol.315(8), pp.788-800
Main Author: Bellani, Giacomo
Other Authors: Laffey, John G , Pham, Tài , Fan, Eddy , Brochard, Laurent , Esteban, Andres , Gattinoni, Luciano , van Haren, Frank , Larsson, Anders , Mcauley, Daniel F , Ranieri, Marco , Rubenfeld, Gordon , Thompson, B Taylor , Wrigge, Hermann , Slutsky, Arthur S , Pesenti, Antonio , Bellani, Giacomo , Francois, Guy M
Format: Electronic Article Electronic Article
Language: English
Subjects:
ID: E-ISSN: 1538-3598 ; DOI: 1538-3598 ; DOI: 10.1001/jama.2016.0291
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title: Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.
format: Article
creator:
  • Bellani, Giacomo
  • Laffey, John G
  • Pham, Tài
  • Fan, Eddy
  • Brochard, Laurent
  • Esteban, Andres
  • Gattinoni, Luciano
  • van Haren, Frank
  • Larsson, Anders
  • Mcauley, Daniel F
  • Ranieri, Marco
  • Rubenfeld, Gordon
  • Thompson, B Taylor
  • Wrigge, Hermann
  • Slutsky, Arthur S
  • Pesenti, Antonio
  • Bellani, Giacomo
  • Francois, Guy M
subjects:
  • Algorithms–Statistics & Numerical Data
  • Female–Statistics & Numerical Data
  • Global Health–Methods
  • Hospital Mortality–Statistics & Numerical Data
  • Humans–Methods
  • Incidence–Statistics & Numerical Data
  • Intensive Care Units–Diagnosis
  • Male–Epidemiology
  • Middle Aged–Mortality
  • Neuromuscular Blockade–Therapy
  • Organ Dysfunction Scores–Therapy
  • Patient Positioning–Therapy
  • Positive-Pressure Respiration–Therapy
  • Prevalence–Therapy
  • Prone Position–Therapy
  • Prospective Studies–Therapy
  • Respiratory Distress Syndrome, Adult–Therapy
  • Severity of Illness Index–Therapy
  • Treatment Outcome–Therapy
  • Abridged
ispartof: JAMA, February 23, 2016, Vol.315(8), pp.788-800
description: IMPORTANCELimited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVESTo evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTSThe Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURESAcute respiratory distress syndrome. MAIN OUTCOMES AND MEASURESThe primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTSOf 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI,
language: eng
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identifier: E-ISSN: 1538-3598 ; DOI: 1538-3598 ; DOI: 10.1001/jama.2016.0291
fulltext: no_fulltext
issn:
  • 15383598
  • 1538-3598
url: Link


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titleEpidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.
creatorBellani, Giacomo ; Laffey, John G ; Pham, Tài ; Fan, Eddy ; Brochard, Laurent ; Esteban, Andres ; Gattinoni, Luciano ; van Haren, Frank ; Larsson, Anders ; Mcauley, Daniel F ; Ranieri, Marco ; Rubenfeld, Gordon ; Thompson, B Taylor ; Wrigge, Hermann ; Slutsky, Arthur S ; Pesenti, Antonio ; Bellani, Giacomo ; Francois, Guy M
contributorRabboni, Francesca (correspondence author) ; Madotto, Fabiana (record owner) ; Conti, Sara ; Sula, Hektor ; Nunci, Lordian ; Cani, Alma ; Zazu, Alan ; Dellera, Christian ; Insaurralde, Carolina S ; Alejandro, Risso V ; Daldin, Julio ; Vinzio, Mauricio ; Fernandez, Ruben O ; Cardonnet, Luis P ; Bettini, Lisandro R ; Bisso, Mariano Carboni ; Osman, Emilio M ; Setten, Mariano G ; Lovazzano, Pablo ; Alvarez, Javier ; Villar, Veronica ; Pozo, Norberto C ; Grubissich, Nicolas ; Plotnikow, Gustavo A ; Vasquez, Daniela N ; Ilutovich, Santiago ; Tiribelli, Norberto ; Chena, Ariel ; Pellegrini, Carlos A ; Saenz, María G ; Estenssoro, Elisa ; Brizuela, Matias ; Gianinetto, Hernan ; Gomez, Pablo E ; Cerrato, Valeria I ; Bezzi, Marco G ; Borello, Silvina A ; Loiacono, Flavia A ; Fernandez, Adriana M ; Knowles, Serena ; Reynolds, Claire ; Inskip, Deborah M ; Miller, Jennene J ; Kong, Jing ; Whitehead, Christina ; Bihari, Shailesh ; Seven, Aylin ; Krstevski, Amanda ; Rodgers, Helen J ; Millar, Rebecca T ; Mckenna, Toni E ; Bailey, Irene M ; Hanlon, Gabrielle C ; Aneman, Anders ; Lynch, Joan M ; Azad, Raman ; Neal, John ; Woods, Paul W ; Roberts, Brigit L ; Kol, Mark R ; Wong, Helen S ; Riss, Katharina C ; Staudinger, Thomas ; Wittebole, Xavier ; Berghe, Caroline ; Bulpa, Pierre A ; Dive, Alain M ; Verstraete, Rik ; Lebbinck, Herve ; Depuydt, Pieter ; Vermassen, Joris ; Meersseman, Philippe ; Ceunen, Helga ; Rosa, Jonas I ; Beraldo, Daniel O ; Piras, Claudio ; Rampinelli, Adenilton M ; Nassar, Antonio P ; Mataloun, Sergio ; Moock, Marcelo ; Thompson, Marlus M ; Gonçalves, Claudio H ; Antônio, Ana Carolina P ; Ascoli, Aline ; Biondi, Rodrigo S ; Fontenele, Danielle C ; Nobrega, Danielle ; Sales, Vanessa M ; Shindhe, Suresh ; Ismail, Dk Maizatul Aiman B Pg Hj ; Laffey, John ; Beloncle, Francois ; Davies, Kyle G ; Cirone, Rob ; Manoharan, Venika ; Ismail, Mehvish ; Goligher, Ewan C ; Jassal, Mandeep ; Ferguson, Niall D ; Nishikawa, Erin ; Javeed, Areej ; Curley, Gerard ; Rittayamai, Nuttapol ; Parotto, Matteo ; Mehta, Sangeeta ; Knoll, Jenny ; Pronovost, Antoine ; Canestrini, Sergio ; Bruhn, Alejandro R ; Garcia, Patricio H ; Aliaga, Felipe A ; Farías, Pamela A ; Yumha, Jacob S ; Ortiz, Claudia A ; Salas, Javier E ; Saez, Alejandro A ; Vega, Luis D ; Labarca, Eduardo F ; Martinez, Felipe T ; Carreño, Nicolás G ; Lora, Pilar ; Liu, Haitao ; Qiu, Haibo ; Liu, Ling ; Tang, Rui ; Luo, Xiaoming ; An, Youzhong ; Zhao, Huiying ; Gao, Yan ; Zhai, Zhe ; Ye, Zheng L ; Wang, Wei ; Li, Wenwen ; Li, Qingdong ; Zheng, Ruiqiang ; Yu, Wenkui ; Shen, Juanhong ; Li, Xinyu ; Yu, Tao ; Lu, Weihua ; Wu, Ya Q ; Huang, Xiao B ; He, Zhenyang ; Lu, Yuanhua ; Han, Hui ; Zhang, Fan ; Sun, Renhua ; Wang, Hua X ; Qin, Shu H ; Zhu, Bao H ; Zhao, Jun ; Liu, Jian ; Li, Bin ; Liu, Jing L ; Zhou, Fa C ; Li, Qiong J ; Zhang, Xing Y ; Li-Xin, Zhou ; Xin-Hua, Qiang ; Jiang, Liangyan ; Gao, Yuan N ; Zhao, Xian Y ; Li, Yuan Y ; Li, Xiao L ; Wang, Chunting ; Yao, Qingchun ; Yu, Rongguo ; Chen, Kai ; Shao, Huanzhang ; Qin, Bingyu ; Huang, Qing Q ; Zhu, Wei H ; Hang, Ai Y ; Hua, Ma X ; Li, Yimin ; Xu, Yonghao ; Di, Yu D ; Ling, Long L ; Qin, Tie H ; Wang, Shou H ; Qin, Junping ; Han, Yi ; Zhou, Suming ; Vargas, Monica P ; Jimenez, Juan I Silesky ; Rojas, Manuel A González ; Solis-Quesada, Jaime E ; Ramirez-Alfaro, Christian M ; Máca, Jan ; Sklienka, Peter ; Gjedsted, Jakob ; Christiansen, Aage ; Nielsen, Jonas ; Villamagua, Boris G ; Llano, Miguel ; Burtin, Philippe ; Buzancais, Gautier ; Beuret, Pascal ; Pelletier, Nicolas ; Mortaza, Satar ; Mercat, Alain ; Chelly, Jonathan ; Jochmans, Sébastien ; Terzi, Nicolas ; Daubin, Cédric ; Carteaux, Guillaume ; de Prost, Nicolas ; Chiche, Jean-Daniel ; Daviaud, Fabrice ; Pham, Tài ; Fartoukh, Muriel ; Barberet, Guillaume ; Biehler, Jerome ; Dellamonica, Jean ; Doyen, Denis ; Arnal, Jean-Michel ; Briquet, Anais ; Klasen, Fanny ; Papazian, Laurent ; Follin, Arnaud ; Roux, Damien ; Messika, Jonathan ; Kalaitzis, Evangelos ; Dangers, Laurence ; Combes, Alain ; Au, Siu-Ming ; Béduneau, Gaetan ; Carpentier, Dorothée ; Zogheib, Elie H ; Dupont, Herve ; Ricome, Sylvie ; Santoli, Francesco L
ispartofJAMA, February 23, 2016, Vol.315(8), pp.788-800
identifier
subjectAlgorithms–Statistics & Numerical Data ; Female–Statistics & Numerical Data ; Global Health–Methods ; Hospital Mortality–Statistics & Numerical Data ; Humans–Methods ; Incidence–Statistics & Numerical Data ; Intensive Care Units–Diagnosis ; Male–Epidemiology ; Middle Aged–Mortality ; Neuromuscular Blockade–Therapy ; Organ Dysfunction Scores–Therapy ; Patient Positioning–Therapy ; Positive-Pressure Respiration–Therapy ; Prevalence–Therapy ; Prone Position–Therapy ; Prospective Studies–Therapy ; Respiratory Distress Syndrome, Adult–Therapy ; Severity of Illness Index–Therapy ; Treatment Outcome–Therapy ; Abridged
descriptionIMPORTANCELimited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVESTo evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTSThe Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURESAcute respiratory distress syndrome. MAIN OUTCOMES AND MEASURESThe primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTSOf 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCEAmong ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS. TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT02010073.
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0Bellani, Giacomo
1Laffey, John G
2Pham, Tài
3Fan, Eddy
4Brochard, Laurent
5Esteban, Andres
6Gattinoni, Luciano
7van Haren, Frank
8Larsson, Anders
9Mcauley, Daniel F
10Ranieri, Marco
11Rubenfeld, Gordon
12Thompson, B Taylor
13Wrigge, Hermann
14Slutsky, Arthur S
15Pesenti, Antonio
16Francois, Guy M
titleEpidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.
descriptionIMPORTANCELimited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVESTo evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTSThe Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURESAcute respiratory distress syndrome. MAIN OUTCOMES AND MEASURESThe primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTSOf 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCEAmong ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS. TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT02010073.
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1Female–Statistics & Numerical Data
2Global Health–Methods
3Hospital Mortality–Statistics & Numerical Data
4Humans–Methods
5Incidence–Statistics & Numerical Data
6Intensive Care Units–Diagnosis
7Male–Epidemiology
8Middle Aged–Mortality
9Neuromuscular Blockade–Therapy
10Organ Dysfunction Scores–Therapy
11Patient Positioning–Therapy
12Positive-Pressure Respiration–Therapy
13Prevalence–Therapy
14Prone Position–Therapy
15Prospective Studies–Therapy
16Respiratory Distress Syndrome, Adult–Therapy
17Severity of Illness Index–Therapy
18Treatment Outcome–Therapy
19Abridged
20NCT02010073
21ClinicalTrials.gov
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7Dellera, Christian
8Insaurralde, Carolina S
9Alejandro, Risso V
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14Bettini, Lisandro R
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17Setten, Mariano G
18Lovazzano, Pablo
19Alvarez, Javier
20Villar, Veronica
21Pozo, Norberto C
22Grubissich, Nicolas
23Plotnikow, Gustavo A
24Vasquez, Daniela N
25Ilutovich, Santiago
26Tiribelli, Norberto
27Chena, Ariel
28Pellegrini, Carlos A
29Saenz, María G
30Estenssoro, Elisa
31Brizuela, Matias
32Gianinetto, Hernan
33Gomez, Pablo E
34Cerrato, Valeria I
35Bezzi, Marco G
36Borello, Silvina A
37Loiacono, Flavia A
38Fernandez, Adriana M
39Knowles, Serena
40Reynolds, Claire
41Inskip, Deborah M
42Miller, Jennene J
43Kong, Jing
44Whitehead, Christina
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56Neal, John
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60Wong, Helen S
61Riss, Katharina C
62Staudinger, Thomas
63Wittebole, Xavier
64Berghe, Caroline
65Bulpa, Pierre A
66Dive, Alain M
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68Lebbinck, Herve
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70Vermassen, Joris
71Meersseman, Philippe
72Ceunen, Helga
73Rosa, Jonas I
74Beraldo, Daniel O
75Piras, Claudio
76Rampinelli, Adenilton M
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98Ferguson, Niall D
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titleEpidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.
authorBellani, Giacomo ; Laffey, John G ; Pham, Tài ; Fan, Eddy ; Brochard, Laurent ; Esteban, Andres ; Gattinoni, Luciano ; van Haren, Frank ; Larsson, Anders ; Mcauley, Daniel F ; Ranieri, Marco ; Rubenfeld, Gordon ; Thompson, B Taylor ; Wrigge, Hermann ; Slutsky, Arthur S ; Pesenti, Antonio ; Bellani, Giacomo ; Francois, Guy M
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6Intensive Care Units–Diagnosis
7Male–Epidemiology
8Middle Aged–Mortality
9Neuromuscular Blockade–Therapy
10Organ Dysfunction Scores–Therapy
11Patient Positioning–Therapy
12Positive-Pressure Respiration–Therapy
13Prevalence–Therapy
14Prone Position–Therapy
15Prospective Studies–Therapy
16Respiratory Distress Syndrome, Adult–Therapy
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8Larsson, Anders
9Mcauley, Daniel F
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15Pesenti, Antonio
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17Rabboni, Francesca
18Madotto, Fabiana
19Conti, Sara
20Sula, Hektor
21Nunci, Lordian
22Cani, Alma
23Zazu, Alan
24Dellera, Christian
25Insaurralde, Carolina S
26Alejandro, Risso V
27Daldin, Julio
28Vinzio, Mauricio
29Fernandez, Ruben O
30Cardonnet, Luis P
31Bettini, Lisandro R
32Bisso, Mariano Carboni
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34Setten, Mariano G
35Lovazzano, Pablo
36Alvarez, Javier
37Villar, Veronica
38Pozo, Norberto C
39Grubissich, Nicolas
40Plotnikow, Gustavo A
41Vasquez, Daniela N
42Ilutovich, Santiago
43Tiribelli, Norberto
44Chena, Ariel
45Pellegrini, Carlos A
46Saenz, María G
47Estenssoro, Elisa
48Brizuela, Matias
49Gianinetto, Hernan
50Gomez, Pablo E
51Cerrato, Valeria I
52Bezzi, Marco G
53Borello, Silvina A
54Loiacono, Flavia A
55Fernandez, Adriana M
56Knowles, Serena
57Reynolds, Claire
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59Miller, Jennene J
60Kong, Jing
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62Bihari, Shailesh
63Seven, Aylin
64Krstevski, Amanda
65Rodgers, Helen J
66Millar, Rebecca T
67Mckenna, Toni E
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69Hanlon, Gabrielle C
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72Azad, Raman
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74Woods, Paul W
75Roberts, Brigit L
76Kol, Mark R
77Wong, Helen S
78Riss, Katharina C
79Staudinger, Thomas
80Wittebole, Xavier
81Berghe, Caroline
82Bulpa, Pierre A
83Dive, Alain M
84Verstraete, Rik
85Lebbinck, Herve
86Depuydt, Pieter
87Vermassen, Joris
88Meersseman, Philippe
89Ceunen, Helga
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atitleEpidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.
jtitleJAMA
risdate20160223
volume315
issue8
spage788
epage800
pages788-800
eissn1538-3598
formatjournal
genrearticle
ristypeJOUR
abstractIMPORTANCELimited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVESTo evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTSThe Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURESAcute respiratory distress syndrome. MAIN OUTCOMES AND MEASURESThe primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTSOf 29,144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCEAmong ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS. TRIAL REGISTRATIONclinicaltrials.gov Identifier: NCT02010073.
doi10.1001/jama.2016.0291
urlhttp://search.proquest.com/docview/1767914006/
issn00987484
date2016-02-23