Practice of diagnosis and management of acute respiratory distress syndrome in mainland China: a cross-sectional study

被引：42

作者：

Liu, Ling ^{[1
]}

Yang, Yi ^{[1
]}

Gao, Zhiwei ^{[1
,2
]}

Li, Maoqin ^{[3
]}

Mu, Xinwei ^{[4
]}

Ma, Xiaochun ^{[5
]}

Li, Guicheng ^{[6
]}

Sun, Wen ^{[7
]}

Wang, Xue ^{[8
]}

Gu, Qin ^{[9
]}

Zheng, Ruiqiang ^{[10
]}

Zhao, Hongsheng ^{[11
]}

Ao, Dan ^{[12
]}

Yu, Wenkui ^{[13
]}

Wang, Yushan ^{[14
]}

Chen, Kang ^{[15
]}

Yan, Jie ^{[16
]}

Li, Jianguo ^{[17
]}

Cai, Guolong ^{[18
]}

Wang, Yurong ^{[19
]}

Wang, Hongliang ^{[20
]}

Kang, Yan ^{[21
]}

Slutsky, Arthur S. ^{[22
]}

Liu, Songqiao ^{[1
]}

Xie, Jianfen ^{[1
]}

Qiu, Haibo ^{[1
]}

机构：

[1] Southeast Univ, Sch Med, Zhongda Hosp, Dept Crit Care Med, Nanjing 210009, Peoples R China

[2] Nanjing Med Univ, Huaian Peoples Hosp 1, Dept Crit Care Med, Huaian 223300, Peoples R China

[3] Xuzhou City Cent Hosp, Dept Crit Care Med, Xuzhou 221009, Jiangsu, Peoples R China

[4] Nanjing Med Univ, Nanjing Hosp 1, Dept Crit Care Med, Nanjing 210029, Jiangsu, Peoples R China

[5] China Med Univ, Hosp 1, Dept Crit Care Med, Shenyang 110001, Peoples R China

[6] Chenzhou First Peoples Hosp, Dept Crit Care Med, Chenzhou 423000, Peoples R China

[7] Jurong Peoples Hosp, Dept Crit Care Med, Jurong 212400, Peoples R China

[8] Xi An Jiao Tong Univ, Dept Crit Care Med, Affiliated Hosp 1, Xian 710061, Peoples R China

[9] Nanjing Univ, Dept Crit Care Med, Nanjing Drum Tower Hosp, Affiliated Hosp,Med Sch, Nanjing 210008, Peoples R China

[10] Northern Jiangsu Peoples Hosp, Dept Crit Care Med, Yangzhou 225000, Jiangsu, Peoples R China

[11] Nantong Univ, Affiliated Hosp, Dept Crit Care Med, Nantong 226001, Peoples R China

[12] Lishui Peoples Hosp, Dept Crit Care Med, Nanjing 210044, Jiangsu, Peoples R China

[13] Nanjing Mil Command, Nanjing Gen Hosp, Dept Crit Care Med, Nanjing 210002, Jiangsu, Peoples R China

[14] Jilin Univ, Hosp 1, Dept Crit Care Med, Changchun 130021, Peoples R China

[15] Zhangjiagang First Peoples Hosp, Dept Crit Care Med, Zhangjiagang 215600, Peoples R China

[16] Wuxi Peoples Hosp, Dept Crit Care Med, Wuxi 214043, Peoples R China

[17] Wuhan Univ, Zhongnan Hosp, Dept Crit Care Med, Wuhan 430071, Peoples R China

[18] Zhejiang Hosp, Dept Crit Care Med, Hangzhou 310030, Zhejiang, Peoples R China

[19] Yangzhou First Peoples Hosp, Dept Crit Care Med, Yangzhou 225001, Jiangsu, Peoples R China

[20] Harbin Med Univ, Affiliated Hosp 2, Dept Crit Care Med, Harbin 150040, Heilongjiang, Peoples R China

[21] West China Sch Med, West China Hosp, Dept Crit Care Med, Chengdu 610041, Peoples R China

[22] Univ Toronto, Interdept Div Crit Care Med, St Michaels Hosp, Res Ctr Biomed Sci,Li Ka Shing Knowledge Inst, Toronto, ON, Canada

来源：

JOURNAL OF THORACIC DISEASE | 2018年 / 10卷 / 09期

关键词：

Clinical epidemiology; acute respiratory distress syndrome (ARDS); mechanical ventilation; mortality; END-EXPIRATORY PRESSURE; ACUTE LUNG INJURY; RECRUITMENT MANEUVERS; DRIVING PRESSURE; TIDAL VOLUMES; VENTILATION; ARDS; UNDERRECOGNITION; MORTALITY; OUTCOMES;

D O I：

10.21037/jtd.2018.08.137

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

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 cmH(2)O) 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 cmH(2)O (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) cmH(2)O and median FiO(2) 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.

引用

页码：5394 / 5404

页数：11

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