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Title:Temporal changes in the epidemiology, management, and outcome from acute respiratory distress syndrome in European intensive care units : a comparison of two large cohorts
Authors:Sakr, Yasser (Author)
François, Bruno (Author)
Solé-Violan, Jordi (Author)
Kotfis, Katarzyna (Author)
Jaschinski, Ulrich (Author)
Estella, Angel (Author)
Leone, Marc (Author)
Jakob, Stephan M. (Author)
Wittebole, Xavier (Author)
Fontes, Luis E. (Author)
Sinkovič, Andreja (Other)
Kerin-Povšič, Milena (Other)
Kosec, Lučka (Other)
Rupnik, Erik (Other)
Voga, Gorazd (Other)
Tomič, Viktorija (Author)
Tipology:1.01 - Original Scientific Article
Organisation:Logo UKPBAG - University Clinic of Respiratory and Allergic Diseases Golnik
Abstract:Background. Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods. This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results. The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion. The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.
Keywords:respiratory insufficiency, artificial respiration, tidal volume, airway pressures, driving pressure
Year of publishing:2021
Publisher:Springer Nature
Source:Velika Britanija
COBISS_ID:57738243 Link is opened in a new window
ISSN on article:1466-609X
DOI:10.1186/s13054-020-03455-8 Link is opened in a new window
Note:Nasl. z nasl. zaslona; Soavtorji: Bruno François, Jordi Solé-Violan, Katarzyna Kotfis, Ulrich Jaschinski, Angel Estella, Marc Leone, Stephan M Jakob, Xavier Wittebole, Luis E Fontes, Miguel de Melo Gurgel, Thais Midega, Jean-Louis Vincent, V Marco Ranieri, SOAP in ICON Investigators; Opis vira z dne 29. 3. 2021; Članek št. 87;
Files:URL URL - Source URL, visit
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Note: Priloga
Journal:Crit. care
Rights:© The Author(s) 2021.
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License:CC BY 4.0, Creative Commons Attribution 4.0 International
Description:This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.
Licensing start date:25.02.2021