Departments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada.
Departments of Anesthesia, Physiology, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Intensive Care Med. 2016 Dec;42(12):1865-1876. doi: 10.1007/s00134-016-4571-5. Epub 2016 Oct 18.
To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality.
The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1-2 who received invasive mechanical ventilation.
2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO/FiO ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores.
Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS.
ClinicalTrials.gov NCT02010073.
为了改善急性呼吸窘迫综合征（ARDS）的预后，需要确定与死亡率相关的潜在可改变因素。
这项大型观察性研究旨在了解全球严重急性呼吸衰竭的影响（LUNG SAFE）是一项国际性、多中心、前瞻性队列研究，纳入了 2014 年冬季来自 5 大洲 50 个国家的 459 家 ICU 的 2377 例严重呼吸衰竭患者。一个预先设定的次要目标是研究与结局相关的因素。分析仅限于在第 1-2 天满足 ARDS 标准且接受有创机械通气的患者。
潜在可改变的因素与多变量分析中增加的住院死亡率相关，包括较低的 PEEP、较高的峰压、平台压和驱动压以及较高的呼吸频率。潮气量对结局的影响尚不清楚。ICU 床位较少也与较高的住院死亡率相关。与 ARDS 预后恶化相关的不可改变因素包括年龄较大、活动性肿瘤、血液系统肿瘤和慢性肝功能衰竭。严重程度指数，包括较低的 pH 值、较低的 PaO/FiO 比值和较高的非肺部 SOFA 评分，与较差的预后相关。在 578 例（24.3%）有生命支持治疗或措施限制决策的患者中，有 498 例（86.0%）在医院死亡。与生命支持治疗或措施限制决策可能性增加相关的因素包括年龄较大、免疫抑制、肿瘤、较低的 pH 值和较高的非肺部 SOFA 评分。
较高的 PEEP、较低的峰压、平台压和驱动压以及较低的呼吸频率与 ARDS 的生存率改善相关。
ClinicalTrials.gov NCT02010073。
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