The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation
Jesús Villar,Jesús Blanco,José M. Añón,Antonio Santos-Bouza,Lluís Blanch,Alfonso Ambrós,Francisco Gandía,Demetrio Carriedo,Fernando Mosteiro,Santiago Basaldúa,Rosa Lidia Fernández,Robert M. Kacmarek +11 more
TLDR
These findings support previous estimates in Europe and are an order of magnitude lower than those reported in the USA and Australia.Abstract:
While our understanding of the pathogenesis and management of acute respiratory distress syndrome (ARDS) has improved over the past decade, estimates of its incidence have been controversial. The goal of this study was to examine ARDS incidence and outcome under current lung protective ventilatory support practices before and after the diagnosis of ARDS. This was a 1-year prospective, multicenter, observational study in 13 geographical areas of Spain (serving a population of 3.55 million at least 18 years of age) between November 2008 and October 2009. Subjects comprised all consecutive patients meeting American-European Consensus Criteria for ARDS. Data on ventilatory management, gas exchange, hemodynamics, and organ dysfunction were collected. A total of 255 mechanically ventilated patients fulfilled the ARDS definition, representing an incidence of 7.2/100,000 population/year. Pneumonia and sepsis were the most common causes of ARDS. At the time of meeting ARDS criteria, mean PaO2/FiO2 was 114 ± 40 mmHg, mean tidal volume was 7.2 ± 1.1 ml/kg predicted body weight, mean plateau pressure was 26 ± 5 cmH2O, and mean positive end-expiratory pressure (PEEP) was 9.3 ± 2.4 cmH2O. Overall ARDS intensive care unit (ICU) and hospital mortality was 42.7% (95%CI 37.7–47.8) and 47.8% (95%CI 42.8–53.0), respectively. This is the first study to prospectively estimate the ARDS incidence during the routine application of lung protective ventilation. Our findings support previous estimates in Europe and are an order of magnitude lower than those reported in the USA and Australia. Despite use of lung protective ventilation, overall ICU and hospital mortality of ARDS patients is still higher than 40%.read more
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Journal ArticleDOI
Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries
Giacomo Bellani,John G. Laffey,John G. Laffey,Tài Pham,Tài Pham,Eddy Fan,Eddy Fan,Laurent Brochard,Laurent Brochard,Andrés Esteban,Luciano Gattinoni,Frank van Haren,Anders Larsson,Daniel F. McAuley,Marco Ranieri,Gordon D. Rubenfeld,Gordon D. Rubenfeld,B. Taylor Thompson,Hermann Wrigge,Arthur S. Slutsky,Antonio Pesenti +20 more
TL;DR: Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning, which indicates the potential for improvement in the management of patients with ARDS.
Journal ArticleDOI
Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial.
Jesús Villar,Jesús Villar,Carlos Ferrando,Carlos Ferrando,Domingo Martínez,Alfonso Ambrós,Tomás Muñoz,Juan A Soler,Gerardo Aguilar,Francisco Alba,Elena González-Higueras,Luís A Conesa,Carmen Martín-Rodríguez,Francisco J Díaz-Domínguez,Pablo Serna-Grande,Rosana Rivas,José Ferreres,Javier Belda,Lucía Capilla,Alec Tallet,José M. Añón,José M. Añón,Rosa Lidia Fernández,Jesús M González-Martín,Julian Alvarez,M.J. Asensio,Jesús María Blanco,Marisa Blasco,Lucia Cachafeiro,Rafael del Campo,José A. Carbonell,Nieves Carbonell,Agustín Cariñena,Demetrio Carriedo,Mario Chico,Ruth Corpas,Javier Cuervo,Cristina Domínguez-Antelo,Lorena Fernández,Eneritz Gamboa,Raúl I. González-Luengo,Ramón Ortiz Díaz-Miguel,Raquel Pérez-González,A. Prieto,Isidro Prieto,Leticia Rojas-Viguera,Miguel A. Romera,Jesús Sánchez-Ballesteros,José M. Segura,Ainhoa Serrano,Rosario Solano,Marina Soro +51 more
TL;DR: Early administration of dexamethasone could reduce duration of mechanical ventilation and overall mortality in patients with established moderate-to-severe ARDS.
Journal ArticleDOI
High-frequency oscillation for acute respiratory distress syndrome.
Duncan Young,Sarah E Lamb,Sanjoy Shah,Iain MacKenzie,William Tunnicliffe,Ranjit Lall,Kathy Rowan,Brian H Cuthbertson +7 more
TL;DR: The use of HFOV had no significant effect on 30-day mortality in patients undergoing mechanical ventilation for ARDS, and the odds ratio for survival in the conventional-ventilation group was 1.03.
Journal ArticleDOI
Formal guidelines: management of acute respiratory distress syndrome
Laurent Papazian,Cecile Aubron,Laurent Brochard,Jean Daniel Chiche,Alain Combes,Didier Dreyfuss,Jean Marie Forel,Claude Guérin,Samir Jaber,Armand Mekontso-Dessap,Alain Mercat,Jean-Christophe Richard,Damien Roux,Antoine Vieillard-Baron,Henri Faure +14 more
TL;DR: For three aspects of ARDS management (driving pressure, early spontaneous ventilation, and extracorporeal carbon dioxide removal), the experts concluded that no sound recommendation was possible given current knowledge.
Journal ArticleDOI
Asynchronies during mechanical ventilation are associated with mortality.
Lluis Blanch,Ana Villagrá,Bernat Sales,Jaume Montanya,Umberto Lucangelo,Manel Luján,Oscar Garcia-Esquirol,Encarna Chacón,Anna Estruga,Joan Carles Oliva,Alberto Hernandez-Abadia,Guillermo M. Albaiceta,Enrique Fernández-Mondéjar,Rafael Fernandez,Josefina López-Aguilar,Jesús Villar,Gastón Murias,Robert M. Kacmarek +17 more
TL;DR: Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime, when patients with an AI above the cutoff are admitted to intensive care unit beds.
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