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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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
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spelling The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.Villar, JesusMora-Ordonez, Juan MSoler, Juan AMosteiro, FernandoVidal, AnxelaAmbros, AlfonsoFernandez, LorenaMurcia, IsabelCivantos, BelenRomera, Miguel AMira, AdrianDiaz-Dominguez, Francisco JParrilla, DacilMartinez-Carmona, J FranciscoMartinez, DomingoPita-Garcia, LidiaRobaglia, DenisBueno-Gonzalez, AnaSanchez-Ballesteros, JesusPereyra, Angel EHernandez, MonicaChamorro-Jambrina, CarlosCobeta, PilarGonzalez-Luengo, Raul IMontiel, RaquelNogales, LeonorFernandez, M MarArocas, BlancaValverde-Montoro, AlvaroDel Saz-Ortiz, Ana MOlea-Jimenez, VictoriaAnon, Jose MRodriguez-Suarez, PedroFernandez, Rosa LFernandez, CristinaSzakmany, TamasGonzalez-Martin, Jesus MFerrando, CarlosKacmarek, Robert MSlutsky, Arthur Sacute hypoxemic respiratory failureacute respiratory distress syndromeepidemiologylung-protective ventilationoutcomepositive end-expiratory pressureOBJECTIVES: 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.LIPPINCOTT WILLIAMS & WILKINS2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/16592Critical Care ExplorationsISSN: 26398028reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p165922026-06-07T16:35:31Z
dc.title.none.fl_str_mv The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
title The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
spellingShingle The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
Villar, Jesus
acute hypoxemic respiratory failure
acute respiratory distress syndrome
epidemiology
lung-protective ventilation
outcome
positive end-expiratory pressure
title_short The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
title_full The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
title_fullStr The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
title_full_unstemmed The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
title_sort The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era.
dc.creator.none.fl_str_mv 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
author Villar, Jesus
author_facet 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
author_role author
author2 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
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv acute hypoxemic respiratory failure
acute respiratory distress syndrome
epidemiology
lung-protective ventilation
outcome
positive end-expiratory pressure
topic acute hypoxemic respiratory failure
acute respiratory distress syndrome
epidemiology
lung-protective ventilation
outcome
positive end-expiratory pressure
description 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.
publishDate 2022
dc.date.none.fl_str_mv 2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/16592
url https://incliva.portalinvestigacion.com/publicaciones/16592
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
publisher.none.fl_str_mv LIPPINCOTT WILLIAMS & WILKINS
dc.source.none.fl_str_mv Critical Care Explorations
ISSN: 26398028
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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