![]() ![]() Quiz Ref ID Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury, associated with increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue. ![]() Trial Registration Identifier: NCT02010073 These findings indicate the potential for improvement in the management of patients with ARDS. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.Ĭonclusions and Relevance Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H 2O. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. Results Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. Main Outcomes and Measures The primary outcome was ICU incidence of ARDS. Objectives To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition.ĭesign, Setting, and Participants The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.Įxposures Acute respiratory distress syndrome. Importance Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.Diagnostic performance of serological tests – test combinations Results of quality assessment per studyĮTable 2. Flow of information through the different phases of the reviewĮTable 1. Search strategy for EMBASE (using )ĮFigure. Search strategy for Medline (using PubMed)ĮAppendix 2. LUNG SAFE Protocol, Statistical Analysis Plan and Case Report FormĮAppendix 1. List of LUNG SAFE InvestigatorsĮAppendix 3. National Coordinators and National Societies/Networks endorsementsĮAppendix 2. Distribution of Ventilator Free Days in patients with ARDSĮAppendix 1. Ventilation parameters in patients in whom plateau pressure was recorded onĮFigure 3. Arterial CO2 tension, arterial pH, tidal volume and plateau pressures inĮFigure 2. Patient and organizational factors associated with neuromuscular blockadeĮFigure 1. Patient and organizational factors associated with prone positioningĮTable 10. Patient and organizational factors associated with higher PEEPĮTable. Patient and organizational factors associated with Pplat measurementĮTable. Patient and organizational factors associated with Higher VTĮTable. Factors included in bivariable and multivariable analysesĮTable. Ventilation of patients with recognized versus unrecognized ARDSĮTable 5. Participating ICUs and patients validated by continent and countryĮTable 4. Amount of missing data for each variable included in the analysisĮTable 3. Characteristics of participating ICUsĮTable 2. ![]()
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