Ibrahim Abdulsalam Saif, Akkari Abdel-Rauof Mahmud, Raza Tasleem, Hassan Ibrahim Fawzy, Akbar Anzila, Alatoum Ibrahim
Division of Medicine Critical Care, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar.
Qatar Med J. 2019 Jul 30;2019(1):3. doi: 10.5339/qmj.2019.3. eCollection 2019.
Although acute respiratory distress syndrome (ARDS) is a common reason for admission to intensive care units, limited information is available about the epidemiological and clinical characteristics of these patients in Middle Eastern countries. Qatar is a high per capita income country with a large multinational expatriate population. Hamad General Hospital is our main tertiary referral center with the largest medical intensive care unit (MICU). A retrospective cross-sectional study was conducted to extract data from the MICU registry for 101 patients aged >14 years who were admitted with ARDS from January 2015 to December 2015. In 2015, a total of 101 (14.8%) of 682 patients admitted to MICU were diagnosed with ARDS. Males comprised 71.3% and females 28.7%. The mean age of the study population was 44.96 ± 17.97 years. Community-acquired bacterial and viral pneumonia were the most common reasons for ARDS. Crude mortality rate was 35%. The mean age of survivors was 42.09 ± 13.58 years compared with 50.36 ± 16.84 years of non-survivors (0.008). Mortality was associated with increasing age, the Acute Physiologic Assessment and Chronic Health Evaluation II severity score, lower P/F ratio, higher Murray's score, higher PCO, lower pH, and circulatory support with vasopressors. Preexisting comorbidities did not contribute to high mortality. No difference in mortality was noted with higher versus lower positive end expiratory pressure. The prone position was used in 8% of the cases. Twenty-seven (27%) patients had undergone salvage therapy with extracorporeal membrane oxygenation (ECMO) that resulted in a survival rate of 44%. ARDS was associated with acute renal failure requiring dialysis in 28.7% of the cases, pneumothoraces in 4%, ventilator-associated pneumonia in 7.9%, and central line-associated bloodstream infection in 2%. ARDS led to a prolonged length of stay compared with the average length of stay in MICU. Community-acquired bacterial and viral pneumonia were the most common causes of ARDS at our center. Critical care outcome correlated with the severity of the disease. ECMO was used as salvage therapy in our center.
尽管急性呼吸窘迫综合征（ARDS）是重症监护病房收治患者的常见原因，但中东国家关于这些患者的流行病学和临床特征的信息有限。卡塔尔是一个人均收入较高的国家，有大量的跨国侨民。哈马德总医院是我们主要的三级转诊中心，拥有最大的医疗重症监护病房（MICU）。我们进行了一项回顾性横断面研究，从MICU登记处提取了2015年1月至2015年12月收治的101例年龄大于14岁的ARDS患者的数据。2015年，MICU收治的682例患者中共有101例（14.8%）被诊断为ARDS。男性占71.3%，女性占28.7%。研究人群的平均年龄为44.96±17.97岁。社区获得性细菌性和病毒性肺炎是ARDS最常见的原因。粗死亡率为35%。幸存者的平均年龄为42.09±13.58岁，而非幸存者为50.36±16.84岁（P = 0.008）。死亡率与年龄增加、急性生理与慢性健康状况评估II严重程度评分、较低的P/F比值、较高的默里评分、较高的PCO₂、较低的pH值以及使用血管升压药的循环支持有关。既往合并症并非导致高死亡率的原因。呼气末正压较高与较低时，死亡率无差异。8%的病例采用了俯卧位。27例（27%）患者接受了体外膜肺氧合（ECMO）挽救治疗，生存率为44%。28.7%的病例中ARDS与需要透析的急性肾衰竭相关，4%与气胸相关，7.9%与呼吸机相关性肺炎相关，2%与中心静脉导管相关血流感染相关。与MICU的平均住院时间相比，ARDS导致住院时间延长。社区获得性细菌性和病毒性肺炎是我们中心ARDS最常见的病因。重症监护结局与疾病严重程度相关。我们中心将ECMO用作挽救治疗。
