Dept of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
Respiratory Dept, Sotiria Chest Diseases Hospital, Athens, Greece.
Eur Respir J. 2018 Mar 29;51(3). doi: 10.1183/13993003.02215-2017. Print 2018 Mar.
Our aim was to assess the incidence, characteristics, aetiology, risk factors and mortality of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU) patients with community-acquired pneumonia (CAP) using the Berlin definition.We prospectively enrolled consecutive mechanically ventilated adult ICU patients with CAP over 20 years, and compared them with mechanically ventilated patients without ARDS. The main outcome was 30-day mortality.Among 5334 patients hospitalised with CAP, 930 (17%) were admitted to the ICU and 432 required mechanical ventilation; 125 (29%) cases met the Berlin ARDS criteria. ARDS was present in 2% of hospitalised patients and 13% of ICU patients. Based on the baseline arterial oxygen tension/inspiratory oxygen fraction ratio, 60 (48%), 49 (40%) and 15 (12%) patients had mild, moderate and severe ARDS, respectively. was the most frequent pathogen, with no significant differences in aetiology between groups. Higher organ system dysfunction and previous antibiotic use were independent risk factors for ARDS in the multivariate analysis, while previous inhaled corticosteroids were independently associated with a lower risk. The 30-day mortality was similar between patients with and without ARDS (25% 30%, p=0.25), confirmed by propensity-adjusted multivariate analysis.ARDS occurs as a complication of CAP in 29% of mechanically ventilated patients, but is not related to the aetiology or mortality.
我们的目的是使用柏林定义评估重症监护病房（ICU）中社区获得性肺炎（CAP）患者急性呼吸窘迫综合征（ARDS）的发生率、特征、病因、危险因素和死亡率。我们前瞻性地纳入了 20 多年来连续机械通气的成年 CAP 重症监护病房患者，并将其与无 ARDS 的机械通气患者进行了比较。主要结局是 30 天死亡率。在 5334 例因 CAP 住院的患者中，930 例（17%）入住 ICU，432 例需要机械通气；125 例（29%）符合柏林 ARDS 标准。ARDS 见于住院患者的 2%和 ICU 患者的 13%。根据基线动脉血氧分压/吸入氧分数比值，60 例（48%）、49 例（40%）和 15 例（12%）患者分别为轻度、中度和重度 ARDS。是最常见的病原体，各组之间病因无显著差异。多变量分析显示，更高的器官系统功能障碍和先前使用抗生素是 ARDS 的独立危险因素，而先前使用吸入性皮质类固醇与较低的风险独立相关。有无 ARDS 的患者 30 天死亡率相似（25%对 30%，p=0.25），这在经过倾向评分调整的多变量分析中得到了证实。ARDS 是机械通气患者中 CAP 的并发症，与病因或死亡率无关。
