Epidemiology of acute hypoxaemic respiratory failure in Australian and New Zealand intensive care units during 2005-2022. A binational, registry-based study.

IF 27.1 1区 医学 Q1 CRITICAL CARE MEDICINE Intensive Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-09-02 DOI:10.1007/s00134-024-07609-y
Ryan Ruiyang Ling, Mallikarjuna Ponnapa Reddy, Ashwin Subramaniam, Benjamin Moran, Kollengode Ramanathan, Mahesh Ramanan, Aidan Burrell, David Pilcher, Kiran Shekar
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Abstract

Purpose: Acute hypoxaemic respiratory failure (AHRF) is a common reason for intensive care unit (ICU) admission. However, patient characteristics, outcomes, and trends over time are unclear. We describe the epidemiology and outcomes of patients with AHRF over time.

Methods: In this binational, registry-based study from 2005 to 2022, we included all adults admitted to an Australian or New Zealand ICU with an arterial blood gas within the first 24 h of ICU stay. AHRF was defined as a partial pressure of oxygen/inspired oxygen ratio (PaO2/FiO2) ≤ 300. The primary outcome was adjusted in-hospital mortality, categorised based on PaO2/FiO2 (mild: 200-300, moderate: 100-200, and severe < 100, and non-linearly). We investigated how adjusted mortality evolved based on temporal trends (by year of admission), sex, age, admission diagnosis and the receipt of mechanical ventilation.

Results: Of 1,560,221 patients, 826,106 (52.9%) were admitted with or developed AHRF within the first 24 h of ICU stay. Of these 826,106 patients, 51.4% had mild, 39.3% had moderate, and 9.3% had severe AHRF. Compared to patients without AHRF (5.3%), patients with mild (8%), moderate (14.2%) and severe (29.9%) AHRF had higher in-hospital mortality rates. As PaO2/FiO2 ratio decreased, adjusted in-hospital mortality progressively increased, particularly below an inflection point at a PaO2/FiO2 ratio of 200. The adjusted in-hospital mortality for all patients decreased over time (13.3% in 2005 to 8.2% in 2022), and this trend was similar in patients with and without AHRF.

Conclusion: The healthcare burden due to AHRF may be larger than expected, and mortality rates remain high in severe AHRF. Although mortality has decreased over time, this may reflect improvements in ICU care in general, rather than specifically in AHRF. More research is required to earlier identify AHRF and stratify these patients at risk of deterioration early, and to validate our findings.

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2005-2022 年澳大利亚和新西兰重症监护病房急性低氧血症呼吸衰竭的流行病学。一项基于登记的两国研究。
目的:急性低氧血症呼吸衰竭(AHRF)是重症监护病房(ICU)入院的常见原因。然而,患者的特征、预后和随时间变化的趋势尚不清楚。我们描述了低氧血症呼吸衰竭患者的流行病学和预后:在 2005 年至 2022 年期间进行的这项基于登记的两国研究中,我们纳入了所有入住澳大利亚或新西兰 ICU 并在入住 ICU 后 24 小时内进行动脉血气检查的成人。AHRF的定义是氧分压/吸入氧比(PaO2/FiO2)≤300。主要结果是调整后的院内死亡率,根据 PaO2/FiO2 进行分类(轻度:200-300;中度:100-200;重度:100-200):结果:在 1,560,221 名患者中,826,106 人(52.9%)在入住重症监护室的头 24 小时内患有或发展为 AHRF。在这 826 106 名患者中,51.4% 的患者为轻度 AHRF,39.3% 的患者为中度 AHRF,9.3% 的患者为重度 AHRF。与无 AHRF 的患者(5.3%)相比,轻度(8%)、中度(14.2%)和重度(29.9%)AHRF 患者的院内死亡率更高。随着 PaO2/FiO2 比值的降低,调整后的院内死亡率逐渐升高,尤其是在 PaO2/FiO2 比值为 200 时的拐点以下。随着时间的推移,所有患者的调整后院内死亡率均有所下降(从2005年的13.3%降至2022年的8.2%),有AHRF和无AHRF患者的这一趋势相似:结论:AHRF 造成的医疗负担可能比预期的要大,严重 AHRF 患者的死亡率仍然很高。虽然随着时间的推移死亡率有所下降,但这可能反映了重症监护病房护理的总体改善,而非专门针对 AHRF。我们需要开展更多的研究,以便更早地识别 AHRF,对这些有恶化风险的患者进行早期分层,并验证我们的研究结果。
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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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