急性呼吸窘迫综合征患者的特征与护理情况：DACAPO队列基线的描述性研究结果及与国际研究结果的比较
Characteristics and provision of care of patients with the acute respiratory distress syndrome: descriptive findings from the DACAPO cohort baseline and comparison with international findings.
作者信息
Dodoo-Schittko Frank, Brandstetter Susanne, Brandl Magdalena, Blecha Sebastian, Quintel Michael, Weber-Carstens Steffen, Kluge Stefan, Meybohm Patrick, Rolfes Caroline, Ellger Björn, Bach Friedhelm, Welte Tobias, Muders Thomas, Thomann-Hackner Kathrin, Bein Thomas, Apfelbacher Christian
机构信息
Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
Department of Anesthesia, Operative Intensive Care, University Hospital Regensburg, Regensburg, Germany.
出版信息
J Thorac Dis. 2017 Mar;9(3):818-830. doi: 10.21037/jtd.2017.03.120.
BACKGROUND
Little is known about the characteristics and real world life circumstances of ARDS (acute respiratory distress syndrome) patient populations. This knowledge is essential for transferring evidence-based therapy into routine healthcare. The aim of this study was to report socio-demographic and clinical characteristics in an unselected population of ARDS patients and to compare these results to findings from other large ARDS cohorts.
METHODS
A German based cross-sectional observational study was carried out. A total of 700 ARDS patients were recruited in 59 study sites between September 2014 and January 2016. Socio-demographic, disease and care related variables were recorded. Additionally, characteristics of other large ARDS cohorts identified by a systematic literature search were extracted into evidence tables.
RESULTS
Median age of ARDS patients was 58 years, 69% were male. Sixty percent had no employment, predominantly due to retirement. Seventy-one percent lived with a partner. The main cause of ARDS was a pulmonary 'direct' origin (79%). The distribution of severity was as follows: mild (14%), moderate (48%), severe (38%). Overall ICU mortality was calculated to be 34%. The observed prevalence of critical events (hypoxemia, hypoglycemia, re-intubation) was 47%. Supportive measures during ICU-treatment were applied to 60% of the patients. Other ARDS cohorts revealed a high heterogeneity in reported concomitant diseases, but sepsis and pneumonia were most frequently reported. Mean age ranged from 54 to 71 years and most patients were male. Other socio-demographic factors have been almost neglected.
CONCLUSIONS
The proportion of patients suffering of mild ARDS was lower compared to the only study identified, which also applied the Berlin definition. The frequency of critical events during ICU treatment was high and the implementation of evidence-based therapy (prone positioning, neuro-muscular blockers) was limited. More evidence on socio-demographic characteristics and further studies applying the current diagnostic criteria are desirable.
背景
对于急性呼吸窘迫综合征（ARDS）患者群体的特征及现实生活状况了解甚少。这些信息对于将循证治疗应用于常规医疗保健至关重要。本研究旨在报告未经挑选的ARDS患者群体的社会人口统计学和临床特征，并将这些结果与其他大型ARDS队列研究的结果进行比较。
方法
开展了一项基于德国的横断面观察性研究。2014年9月至2016年1月期间，在59个研究地点共招募了700例ARDS患者。记录了社会人口统计学、疾病及护理相关变量。此外，通过系统文献检索确定的其他大型ARDS队列研究的特征被提取到证据表中。
结果
ARDS患者的中位年龄为58岁，69%为男性。60%的患者没有工作，主要原因是退休。71%的患者与伴侣同住。ARDS的主要病因是肺部“直接”病因（79%）。严重程度分布如下：轻度（14%）、中度（48%）、重度（38%）。总体ICU死亡率计算为34%。观察到的危急事件（低氧血症、低血糖、再次插管）发生率为47%。60%的患者在ICU治疗期间接受了支持性措施。其他ARDS队列研究显示，所报告的合并症存在高度异质性，但脓毒症和肺炎是最常报告的。平均年龄在54至71岁之间，大多数患者为男性。其他社会人口统计学因素几乎被忽视。
结论
与唯一一项同样采用柏林定义的研究相比，轻度ARDS患者的比例较低。ICU治疗期间危急事件的发生率较高，循证治疗（俯卧位通气、神经肌肉阻滞剂）的实施有限。需要更多关于社会人口统计学特征的证据以及采用当前诊断标准的进一步研究。
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