The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.

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 pros...

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Detalles Bibliográficos
Autores: Villar, Jesus, Mora-Ordonez, Juan M, Soler, Juan A, Mosteiro, Fernando, Vidal, Anxela, Ambros, Alfonso, Fernandez, Lorena, Murcia, Isabel, Civantos, Belen, Romera, Miguel A, Mira, Adrian, Diaz-Dominguez, Francisco J, Parrilla, Dacil, Martinez-Carmona, J Francisco, Martinez, Domingo, Pita-Garcia, Lidia, Robaglia, Denis, Bueno-Gonzalez, Ana, Sanchez-Ballesteros, Jesus, Pereyra, Angel E, Hernandez, Monica, Chamorro-Jambrina, Carlos, Cobeta, Pilar, Gonzalez-Luengo, Raul I, Montiel, Raquel, Nogales, Leonor, Fernandez, M Mar, Arocas, Blanca, Valverde-Montoro, Alvaro, Del Saz-Ortiz, Ana M, Olea-Jimenez, Victoria, Anon, Jose M, Rodriguez-Suarez, Pedro, Fernandez, Rosa L, Fernandez, Cristina, Szakmany, Tamas, Gonzalez-Martin, Jesus M, Ferrando, Carlos, Kacmarek, Robert M, Slutsky, Arthur S
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Institución:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p16592
Acceso en línea:https://incliva.portalinvestigacion.com/publicaciones/16592
Access Level:acceso abierto
Palabra clave:acute hypoxemic respiratory failure
acute respiratory distress syndrome
epidemiology
lung-protective ventilation
outcome
positive end-expiratory pressure
Descripción
Sumario: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 Pao(2)/Fio(2) = 300 mm Hg on positive end-expiratory pressure [PEEP] = 5 cm H(2)O and Fio(2) = 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 H(2)O, Fio(2) 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H(2)O. ARDS patients received higher Fio(2) and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H(2)O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H(2)O, 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.

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