Seitaro Fujishima1, Satoshi Gando2,3, Daizoh Saitoh4, Shigeki Kushimoto5, Hiroshi Ogura6, Toshikazu Abe7,8, Atsushi Shiraishi9, Toshihiko Mayumi10, Junichi Sasaki11, Joji Kotani12, Naoshi Takeyama13, Ryosuke Tsuruta14, Kiyotsugu Takuma15, Norio Yamashita16, Shin-Ichiro Shiraishi17, Hiroto Ikeda18, Yasukazu Shiino19, Takehiko Tarui20, Taka-Aki Nakada21, Toru Hifumi22, Yasuhiro Otomo23, Kohji Okamoto24, Yuichiro Sakamoto25, Akiyoshi Hagiwara26, Tomohiko Masuno27, Masashi Ueyama28, Satoshi Fujimi29, Kazuma Yamakawa29, Yutaka Umemura6. 1. Center for General Medicine Education, Keio University School of Medicine, Japan. 2. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Japan. 3. Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Japan. 4. Division of Traumatology, Research Institute, National Defense Medical College, Japan. 5. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan. 6. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan. 7. Department of General Medicine, Juntendo University, Japan. 8. Health Services Research and Development Center, University of Tsukuba, Japan. 9. Emergency and Trauma Center, Kameda Medical Center, Japan. 10. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan. 11. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Japan. 12. Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan. 13. Advanced Critical Care Center, Aichi Medical University Hospital, Japan. 14. Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Japan. 15. Emergency & Critical Care Center, Kawasaki Municipal Hospital, Japan. 16. Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Japan. 17. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Japan. 18. Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Japan. 19. Department of Acute Medicine, Kawasaki Medical School, Japan. 20. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Japan. 21. Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine, Japan. 22. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan. 23. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Japan. 24. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Japan. 25. Emergency and Critical Care Medicine, Saga University Hospital, Japan. 26. Center Hospital of the National Center for Global Health and Medicine, Japan. 27. Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan. 28. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Japan. 29. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Monserrat E Granados-Bolivar; Miguel Quesada-Caballero; Nora Suleiman-Martos; José L Romero-Béjar; Luis Albendín-García; Guillermo A Cañadas-De la Fuente; Alberto Caballero-Vázquez Journal: Medicina (Kaunas) Date: 2022-05-28 Impact factor: 2.948