Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2024-09-01 DOI:10.1016/j.ccrj.2024.05.001

Rachael L. Parke RN, PhD , Shay P. McGuinness MBChB , Alana Cavadino PhD , Keri-Anne Cowdrey RN, MN , Samantha Bates RN, MN , Shailesh Bihari MBBS, PhD , Amanda Corley RN, PhD , Eileen Gilder RN, PhD , Carol Hodgson PhD , Edward Litton MBChB, PhD , Colin McArthur MBChB , Alistair Nichol MBBCh, PhD , Jane Parker RN, MPH , Anne Turner RN, MPH , Steve Webb MBBS, PhD , Frank MP. Van Haren MD, PhD , SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group

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Abstract

Objective

Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice.

Design

Bi-national, prospective, observational, multi-centre study.

Setting

19 ICUs in Australia and New Zealand.

Participants

Mechanically ventilated patients with moderate-severe ARDS.

Main outcome measures

Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.

Results

200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO₂/FiO₂ ratio 119 (89, 142), median (IQR) FiO₂ 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH₂O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H₂O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61).

Conclusions

In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.

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澳大利亚和新西兰严重急性呼吸窘迫综合征的管理（SAGE-ANZ）：观察研究

目的急性呼吸窘迫综合征（ARDS）与严重的死亡率、发病率和成本相关。我们旨在描述澳大利亚和新西兰重症监护病房（ICU）收治的中重度ARDS成人患者的特征和管理情况，以便更好地了解当代的实践。结果200名参与者，平均（±SD）年龄为55.5（±15.9）岁，40%（n = 80）为女性。约半数（51.5%）患者无基线合并症，45人（31%）COVID-19检测呈阳性。第一天，平均 SOFA 评分为 9 ± 3；PaO2/FiO2 比率中位数（IQR）为 119（89，142），FiO2 中位数（IQR）为 70%（50%，99%），呼气末正压（PEEP）平均值（±SD）为 11（±3）cmH2O。第一天，10.5%（n = 21）的患者接受了肺保护性通气（LPV）（潮气量≤6.5 mL/kg预测体重，高原压或峰值压≤30 cm H2O）。86%的患者（n = 172）在入组至第 28 天的某个阶段接受了辅助治疗。使用最多的是全身类固醇（127 人），其次是神经肌肉阻滞剂（122 人）和俯卧位（27 人）。截至第28天的无呼吸机天数中位数（IQR）为5天（0，20）。结论在澳大利亚和新西兰，包括 LPV 和俯卧位在内的循证疗法在该队列中的依从性很低。在澳大利亚和新西兰，包括 LPV 和俯卧位在内的循证实践的依从性较低。在中度重度 ARDS 患者的治疗中，肺保护性通气和俯卧位等已证实有效的疗法并未得到常规采用。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.