Department of Critical Care Medicine and.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Ann Am Thorac Soc. 2019 Oct;16(10):1263-1272. doi: 10.1513/AnnalsATS.201812-910OC.
Limited data on the epidemiology of acute respiratory distress syndrome (ARDS) using a standardized screening program exist. To describe the population-based incidence of hypoxemic respiratory failure and ARDS using a prospective standardized screening protocol; and to describe the mechanical ventilation practice and the mechanical power and examine their association with 28-day and 3-year survival outcomes. A prospective standardized screening program for ARDS, as a quality improvement initiative, was initiated at four adult intensive care units over a 27-month period. An ancillary analysis of this observational cohort was performed. Patients requiring mechanical ventilation for ≥24 hours underwent prospective and consecutive screening using standardized ventilator settings. Patient physiological data and outcomes were collected prospectively through an electronic clinical-information system and retrospectively analyzed to apply Berlin criteria. Screened were 7,944 patients, among which 986 (12.4%) had hypoxemic respiratory failure (arterial oxygen tension to inspired fraction of oxygen ratio ≤300), and 731 (9.2%) met criteria for ARDS. Age-adjusted incidence of hypoxemic respiratory failure and ARDS were 37.7 and 27.6 cases per 100,000 person-years, respectively. Patients sustaining the diagnosis of ARDS had a hospital mortality of 26.5% for mild, 31.8% for moderate, and 60.0% for severe ARDS and a 3-year mortality of 43.5% for mild, 46.9% for moderate, and 71.1% for severe ARDS. Mechanical power >22 J/min was associated with increased 28-day hospital and 3-year mortality. Determinants of mechanical power associated with lower 28-day hospital and 3-year survival included plateau pressure >30 cm HO and driving pressure >15 cm HO, but not tidal volumes >8 ml/kg of predicted body weight. Using standardized screening, a large proportion of patients with hypoxemic respiratory failure met criteria for ARDS. Increasing ARDS severity was associated with increased 28-day hospital and 3-year mortality. Increased mechanical power was associated with increased mortality. Potentially modifiable determinants of mechanical power associated with lower survival included plateau pressure and driving pressure.
目前关于急性呼吸窘迫综合征（ARDS）的流行病学数据有限，采用标准化筛查方案。本研究旨在使用前瞻性标准化筛查方案，描述基于人群的低氧性呼吸衰竭和 ARDS 的发生率；并描述机械通气的实施情况和机械功率，并探讨其与 28 天和 3 年生存率的关系。一项针对 ARDS 的前瞻性标准化筛查方案作为一项质量改进计划，在四个成人重症监护病房进行了为期 27 个月的前瞻性研究。对该观察队列进行了辅助分析。需要机械通气治疗≥24 小时的患者使用标准化的呼吸机设置进行前瞻性和连续筛查。患者的生理数据和结局通过电子临床信息系统进行前瞻性收集，并通过回顾性分析应用柏林标准。共筛查了 7944 例患者，其中 986 例（12.4%）患有低氧性呼吸衰竭（动脉血氧分压与吸入氧分数比值≤300），731 例（9.2%）符合 ARDS 标准。校正年龄后，低氧性呼吸衰竭和 ARDS 的发生率分别为每 10 万人年 37.7 例和 27.6 例。诊断为 ARDS 的患者中，轻度 ARDS 的院内死亡率为 26.5%，中度 ARDS 为 31.8%，重度 ARDS 为 60.0%，轻度 ARDS 的 3 年死亡率为 43.5%，中度 ARDS 为 46.9%，重度 ARDS 为 71.1%。机械功率＞22 J/min 与 28 天院内和 3 年死亡率增加相关。与 28 天院内和 3 年生存率降低相关的机械功率决定因素包括平台压＞30 cmH2O 和驱动压＞15 cmH2O，但不包括潮气量＞8 ml/kg 预测体重。使用标准化筛查，很大一部分低氧性呼吸衰竭患者符合 ARDS 标准。ARDS 严重程度增加与 28 天院内和 3 年死亡率增加相关。机械功率增加与死亡率增加相关。与生存率降低相关的可调节机械功率决定因素包括平台压和驱动压。
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