Nolan S, Burgess K, Hopper L, Braude S
Intensive Care Unit, Manly Hospital, NSW, Australia.
Intensive Care Med. 1997 May;23(5):530-8. doi: 10.1007/s001340050369.
To estimate the incidence of the acute respiratory distress syndrome (ARDS) in an Australian urban community, and to describe the pattern of disease and outcomes in a community hospital intensive care unit (ICU).
An eight-bed general ICU in a community hospital.
Retrospective chart review.
32 patients identified over a 4-year period as having ARDS.
The incidence of ARDS in an Australian urban community was estimated to be 7.3-9.3 cases/100,000 population per year. In-hospital mortality was 59%, while ICU mortality was 47%. Sepsis, pneumonia and aspiration were the main aetiological factors accounting for 94% of the patient population. There was no trauma. The Acute Physiology and Chronic Health Evaluation and Murray scores and values for the ratio of the partial pressure of oxygen in arterial blood and fractional inspired oxygen on admission to the ICU were similar between survivors and nonsurvivors, and none of these parameters were reliable predictors of outcome. Mean age, however, was different between survivors (56 +/- 16 years) and non-survivors (69 +/- 9 years) (p < or = 0.01). Mean daily fluid balance was also different between survivors (536 +/- 545 ml/day) and non-survivors (1576 +/- 1255 ml/day) (p < or = 0.02). Haemodynamic data were collected on 21 of the 32 patients within 72 h of the onset of ARDS. None of the haemodynamic parameters reached significance. There was, however, a trend for better cardiac function and oxygen consumption in the survivors.
These data show that for ARDS, at least, mortality outcome can be comparable in a community ICU to a tertiary referral institution. The pattern of disease in an urban Australian community hospital is different to that often reported from tertiary centres. The incidence of ARDS in an Australian urban community is comparable to the reported incidence in North America and Western Europe.
评估澳大利亚城市社区中急性呼吸窘迫综合征（ARDS）的发病率，并描述社区医院重症监护病房（ICU）中该疾病的发病模式及转归情况。
一家社区医院的拥有8张床位的综合ICU。
回顾性病历审查。
在4年期间内确诊为ARDS的32例患者。
澳大利亚城市社区中ARDS的发病率估计为每年7.3 - 9.3例/10万人口。住院死亡率为59%，而ICU死亡率为47%。脓毒症、肺炎和误吸是主要病因，占患者总数的94%。无创伤病例。急性生理学与慢性健康状况评估（APACHE）评分、Murray评分以及入住ICU时动脉血氧分压与吸入氧分数值的比值，在存活者和非存活者之间相似，且这些参数均不是可靠的预后预测指标。然而，存活者（56±16岁）与非存活者（69±9岁）的平均年龄不同（p≤0.01）。存活者（536±545毫升/天）与非存活者（1576±1255毫升/天）的平均每日液体平衡也不同（p≤0.02）。在ARDS发病72小时内，对32例患者中的21例收集了血流动力学数据。没有血流动力学参数具有统计学意义。然而，存活者的心脏功能和氧消耗有改善的趋势。
这些数据表明，至少对于ARDS而言，社区ICU的死亡率与三级转诊机构相当。澳大利亚城市社区医院的疾病模式与三级中心通常报道的不同。澳大利亚城市社区中ARDS的发病率与北美和西欧报道的发病率相当。
