Fujishima Seitaro, Gando Satoshi, Saitoh Daizoh, Kushimoto Shigeki, Ogura Hiroshi, Abe Toshikazu, Shiraishi Atsushi, Mayumi Toshihiko, Sasaki Junichi, Kotani Joji, Takeyama Naoshi, Tsuruta Ryosuke, Takuma Kiyotsugu, Yamashita Norio, Shiraishi Shin-Ichiro, Ikeda Hiroto, Shiino Yasukazu, Tarui Takehiko, Nakada Taka-Aki, Hifumi Toru, Otomo Yasuhiro, Okamoto Kohji, Sakamoto Yuichiro, Hagiwara Akiyoshi, Masuno Tomohiko, Ueyama Masashi, Fujimi Satoshi, Yamakawa Kazuma, Umemura Yutaka
Center for General Medicine Education, Keio University School of Medicine, Japan.
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Japan.
Shock. 2020 May;53(5):544-549. doi: 10.1097/SHK.0000000000001416.
Acute respiratory distress syndrome (ARDS) remains a major cause of death. Epidemiology should be continually examined to refine therapeutic strategies for ARDS. We aimed to elucidate demographics, treatments, and outcomes of ARDS in Japan.
This is a prospective cohort study for ARDS. We included adult patients admitted to intensive care units through emergency and critical care departments who satisfied the American-European Consensus Conference (AECC) acute lung injury (ALI) criteria. In addition, the fulfillment of the Berlin definition was assessed. Logistic regression analyses were used to examine the association of independent variables with outcomes.
Our study included 166 patients with AECC ALI from 34 hospitals in Japan; among them, 157 (94.6%) fulfilled the Berlin definition. The proportion of patients with PaO2/FIO2 ≤ 100, patients under invasive positive pressure ventilation (IPPV), and in-hospital mortality was 39.2%, 92.2%, and 38.0% for patients with AECC ALI and 38.9%, 96.8%, and 37.6% for patients with Berlin ARDS, respectively. The area of lung infiltration was independently associated with outcomes of ARDS. Low-mid-tidal volume ventilation was performed in 75% of patients under IPPV. Glucocorticoid use was observed in 54% patients, and it was positively associated with mortality.
Our study included a greater percentage of patients with ARDS with high severity and found that the overall mortality was 38%. The management of ARDS in Japan was characterized by high the utilization rate of glucocorticoids, which was positively associated with mortality.
急性呼吸窘迫综合征（ARDS）仍然是主要的死亡原因。应持续研究其流行病学，以完善ARDS的治疗策略。我们旨在阐明日本ARDS患者的人口统计学特征、治疗方法及预后情况。
这是一项针对ARDS的前瞻性队列研究。我们纳入了通过急诊和重症监护部门收治入重症监护病房、符合欧美共识会议（AECC）急性肺损伤（ALI）标准的成年患者。此外，还评估了柏林定义的符合情况。采用逻辑回归分析来检验自变量与预后的相关性。
我们的研究纳入了来自日本34家医院的166例符合AECC ALI标准的患者；其中，157例（94.6%）符合柏林定义。对于符合AECC ALI标准的患者，动脉血氧分压/吸入氧分数值（PaO2/FIO2）≤100的患者比例、接受有创正压通气（IPPV）的患者比例及院内死亡率分别为39.2%、92.2%和38.0%；对于符合柏林ARDS定义的患者，上述比例分别为38.9%、96.8%和37.6%。肺浸润面积与ARDS的预后独立相关。75%接受IPPV的患者采用了中低潮气量通气。54% 的患者使用了糖皮质激素，且其使用与死亡率呈正相关。
我们的研究纳入了更高比例的重度ARDS患者，发现总体死亡率为38%。日本对ARDS的治疗特点是糖皮质激素使用率高，且其使用与死亡率呈正相关。
