학술논문
The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era
Document Type
Academic Journal
Author
Villar, Jesús; Mora-Ordoñez, Juan M.; Soler, Juan A.; Mosteiro, Fernando; Vidal, Anxela; Ambrós, Alfonso; Fernández, Lorena; Murcia, Isabel; Civantos, Belén; Romera, Miguel A.; Mira, Adrián; Díaz-Domínguez, Francisco J.; Parrilla, Dácil; Martínez-Carmona, J. Francisco; Martínez, Domingo; Pita-García, Lidia; Robaglia, Denis; Bueno-González, Ana; Sánchez-Ballesteros, Jesús; Pereyra, Ángel E.; Hernández, Mónica; Chamorro-Jambrina, Carlos; Cobeta, Pilar; González-Luengo, Raúl I.; Montiel, Raquel; Nogales, Leonor; Fernández, M. Mar; Arocas, Blanca; Valverde-Montoro, Álvaro; del Saz-Ortiz, Ana M.; Olea-Jiménez, Victoria; Añón, José M.; Rodríguez-Suárez, Pedro; Fernández, Rosa L.; Fernández, Cristina; Szakmany, Tamas; González-Martín, Jesús M.; Ferrando, Carlos; Kacmarek, Robert M.; Slutsky, Arthur S.; Añón, José M.; Civantos, Belén; Hernández, Mónica; González, Elena; Solano, Rosario; Díaz-Domínguez, F. Javier; Carriedo, Demetrio; González Luengo, Raul I.; Ferrando, Carlos; Arocas, Blanca; Belda, Javier; Soro, Marina; Aguilar, Gerardo; Pastor, Ernesto; Fernández, Lorena; Sánchez-Ballesteros, Jesús; Muriel, Arturo; Blanco-Schweizer, Pablo; de Ayala, José Ángel; Blanco, Jesús; Aldecoa, César; Pérez, Alba; Rico-Feijoo, Jesús; Nogales, Leonor; Andaluz, David; Parra, Laura; Soler, Juan A.; Martínez, Domingo; del Saz-Ortiz, Ana M.; Ambrós, Alfonso; Bueno-González, Ana; Hornos-López, Carmen; Montiel, Raquel; Parrilla, Dácil; Peinado, Eduardo; Prieto, Isidro; Chico, Mario; Romera, Miguel A.; Chamorro-Jambrina, Carlos; Mora-Ordoñez, Juan M.; Martínez-Carmona, J. Francisco; Valverde-Montoro, Álvaro; Olea-Jiménez, Victoria; Alba, Paco; Corpas, Ruth; Mosteiro, Fernando; Pita-García, Lidia; Merayo, Eleuterio; Martínez, Chanel; de Célis-Álvarez, Ángeles; Martín-Delgado, Carmen; Mira, Adrián; Cobeta, Pilar; Pestaña, David; del Mar Fernández, María; Tarancón, Concepción; Cortés-Díaz, Silvia; Vidal, Anxela; Robaglia, Denis; Pérez, César; Murcia, Isabel; Pereyra-Pache, Ángel E.; Szakmany, Tamas; Villar, Jesús; Fernández, Rosa L.; Fernández, Cristina; Rodríguez-Pérez, Pedro; González-Martín, Jesús M.; Kacmarek, Robert M.; Slutsky, Arthur S.
Source
Critical Care Explorations. May 01, 2022 4(5):e0684-e0684
Subject
Language
English
ISSN
2639-8028
Abstract
OBJECTIVES:: To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN:: A 6-month prospective, epidemiological, observational study. SETTING:: A network of 22 multidisciplinary ICUs in Spain. PATIENTS:: Consecutive mechanically ventilated patients with AHRF (defined as PaO2/FIO2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and FIO2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, FIO2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher FIO2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837). CONCLUSIONS:: AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.