Ling Liu1, Yi Yang1, Zhiwei Gao1,2, Maoqin Li3, Xinwei Mu4, Xiaochun Ma5, Guicheng Li6, Wen Sun7, Xue Wang8, Qin Gu9, Ruiqiang Zheng10, Hongsheng Zhao11, Dan Ao12, Wenkui Yu13, Yushan Wang14, Kang Chen15, Jie Yan16, Jianguo Li17, Guolong Cai18, Yurong Wang19, Hongliang Wang20, Yan Kang21, Arthur S Slutsky22, Songqiao Liu1, Jianfen Xie1, Haibo Qiu1. 1. Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China. 2. Department of Critical Care Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223300, China. 3. Department of Critical Care Medicine, Xuzhou City Central Hospital, Xuzhou 221009, China. 4. Department of Critical Care Medicine, Nanjing First hospital, Nanjing Medical University, Nanjing 210029, China. 5. Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang 110001, China. 6. Department of Critical Care Medicine, Chenzhou First People's Hospital, Chenzhou 423000, China. 7. Department of Critical Care Medicine, Jurong People's Hospital, Jurong 212400, China. 8. Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China. 9. Department of Critical Care Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Nanjing 210008, China. 10. Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou 225000, China. 11. Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong University, Nantong 226001, China. 12. Department of Critical Care Medicine, Lishui People's Hospital, Nanjing 210044, China. 13. Department of Critical Care Medicine, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China. 14. Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun 130021, China. 15. Department of Critical Care Medicine, Zhangjiagang First People's Hospital, Zhangjiagang 215600, China. 16. Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi 214043, China. 17. Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan 430071, China. 18. Department of Critical Care Medicine, Zhejiang Hospital, Hangzhou 310030, China. 19. Department of Critical Care Medicine, Yangzhou First People's Hospital, Yangzhou 225001, China. 20. Department of Critical Care Medicine, The Second Affiliated Hospital, Harbin Medical University, Harbin 150040, China. 21. Department of Critical Care Medicine, West China Hospital, West China School of Medicine, Chengdu 610041, China. 22. Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Although acute respiratory distress syndrome (ARDS) has been recognized for more than 50 years, limited information exists about the incidence and management of ARDS in mainland China. To evaluate the potential for improvement in management of patients with ARDS, this study was designed to describe the incidence and management of ARDS in mainland China. METHODS: National prospective multicenter observational study over one month (August 31st to September 30th, 2012) of all patients who fulfilled the Berlin or American European Consensus Conference (AECC) definition of ARDS in 20 intensive care units, with data collection related to the management of ARDS, patient characteristics and outcomes. RESULTS: Of the 1,814 patients admitted during the enrollment period, 149 (8.2%) and 147 (8.1%) patients were diagnosed by AECC and Berlin definition, respectively. Lung protective strategy with low tidal volume (Vt) (≤8 mL/kg) and limitation of the plateau pressure (Pplat) (≤30 cmH2O) was performed in 75.2% patients. And, 36%, 21.1% and 4.1% patients with severe, moderate and mild ARDS had the driving pressure more than 14 cmH2O (P<0.05). Pplat and driving pressure increased significantly in patients with a higher degree of ARDS severity (P=0.002 and P<0.001, respectively), but Vt were comparable in the three groups (P>0.05). In severe ARDS, patient median positive end expiratory pressure (PEEP) was 10.0 (8.0-11.3) cmH2O and median FiO2 was 90%. A recruitment maneuver was performed in 35.5% of the patients, and 8.7% of patients with severe ARDS received prone position. Overall hospital mortality was 34.0%. Hospital mortality was 21.8% for mild, 31.1% for moderate, and 60.0% for patients with severe ARDS (P=0.004). CONCLUSIONS: Despite general acceptance of low Vt and limited Pplat, high driving pressure, low PEEP and low use of adjunctive measures may still be a concern in mainland China, especially in patients with severe ARDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT01666834; date of registration release: August 14th 2012.
BACKGROUND: Although acute respiratory distress syndrome (ARDS) has been recognized for more than 50 years, limited information exists about the incidence and management of ARDS in mainland China. To evaluate the potential for improvement in management of patients with ARDS, this study was designed to describe the incidence and management of ARDS in mainland China. METHODS: National prospective multicenter observational study over one month (August 31st to September 30th, 2012) of all patients who fulfilled the Berlin or American European Consensus Conference (AECC) definition of ARDS in 20 intensive care units, with data collection related to the management of ARDS, patient characteristics and outcomes. RESULTS: Of the 1,814 patients admitted during the enrollment period, 149 (8.2%) and 147 (8.1%) patients were diagnosed by AECC and Berlin definition, respectively. Lung protective strategy with low tidal volume (Vt) (≤8 mL/kg) and limitation of the plateau pressure (Pplat) (≤30 cmH2O) was performed in 75.2% patients. And, 36%, 21.1% and 4.1% patients with severe, moderate and mild ARDS had the driving pressure more than 14 cmH2O (P<0.05). Pplat and driving pressure increased significantly in patients with a higher degree of ARDS severity (P=0.002 and P<0.001, respectively), but Vt were comparable in the three groups (P>0.05). In severe ARDS, patient median positive end expiratory pressure (PEEP) was 10.0 (8.0-11.3) cmH2O and median FiO2 was 90%. A recruitment maneuver was performed in 35.5% of the patients, and 8.7% of patients with severe ARDS received prone position. Overall hospital mortality was 34.0%. Hospital mortality was 21.8% for mild, 31.1% for moderate, and 60.0% for patients with severe ARDS (P=0.004). CONCLUSIONS: Despite general acceptance of low Vt and limited Pplat, high driving pressure, low PEEP and low use of adjunctive measures may still be a concern in mainland China, especially in patients with severe ARDS. TRIAL REGISTRATION: ClinicalTrials.gov NCT01666834; date of registration release: August 14th 2012.
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