TY - JOUR
T1 - Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study
AU - Neto, Ary Serpa
AU - Barbas, Carmen S. V.
AU - Simonis, Fabienne D.
AU - Artigas-Raventós, Antonio
AU - Canet, Jaume
AU - Determann, Rogier M.
AU - Anstey, James
AU - Hedenstierna, Goran
AU - Hemmes, Sabrine N. T.
AU - Hermans, Greet
AU - Hiesmayr, Michael
AU - Hollmann, Markus W.
AU - Jaber, Samir
AU - Martin-Loeches, Ignacio
AU - Mills, Gary H.
AU - Pearse, Rupert M.
AU - Putensen, Christian
AU - Schmid, Werner
AU - Severgnini, Paolo
AU - Smith, Roger
AU - Treschan, Tanja A.
AU - Tschernko, Edda M.
AU - Melo, Marcos F. V.
AU - Wrigge, Hermann
AU - de Abreu, Marcelo Gama
AU - Pelosi, Paolo
AU - Schultz, Marcus J.
AU - AUTHOR GROUP
AU - Bell, Adam
AU - Gecaj-Gashi, Agreta
AU - Dilek, Ahmet
AU - Denker, Ahmet Sukru
AU - Aytulun, Akut
AU - Kienbaum, Peter
AU - Rose, Alastair
AU - Bacuzzi, Alessandro
AU - Cavalcanti, Alexandre Biasi
AU - Chan, Alexandre
AU - Molin, Alexandre
AU - Ghosh, Alison
AU - Roy, Alistair
AU - Cowton, Amanda
AU - Skinner, Amanda
AU - Whileman, Amanda
AU - McInerney, Amy
AU - Peçanha, Ana Carolina
AU - Cortegiani, Andrea
AU - Sribar, Andrej
AU - Bentley, Andrew
AU - Corner, Andrew
AU - Kuiper, Michael
PY - 2016
Y1 - 2016
N2 - Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed. Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27-33), representing 0·14 cases per ICU bed over a 1-week period. VT was similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7-9·1] vs 7·9 mL/kg PBW [6·8-9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0-8·0] vs 5·0 cm H2O [5·0-7·0]; p <0·0001). The prevalence of ARDS in patients at risk of ARDS was higher than in individuals not at risk of ARDS (19/260 [7%] vs 17/556 [3%]; p=0·004). Compared with individuals not at risk of ARDS, patients at risk of ARDS had higher in-hospital mortality (86/543 [16%] vs 74/232 [32%]; p <0·0001), ICU mortality (62/533 [12%] vs 66/227 [29%]; p <0·0001), and 90-day mortality (109/653 [17%] vs 88/282 [31%]; p <0·0001). VT did not differ between patients who did and did not develop ARDS (p=0·471 for those at risk of ARDS; p=0·323 for those not at risk). Around a third of patients receiving mechanical ventilation in the ICU were at risk of ARDS. Pulmonary complications occur frequently in patients at risk of ARDS and their clinical outcome is worse compared with those not at risk of ARDS. There is potential for improvement in the management of patients without ARDS. Further refinements are needed for prediction of ARDS. None
AB - Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed. Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27-33), representing 0·14 cases per ICU bed over a 1-week period. VT was similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7-9·1] vs 7·9 mL/kg PBW [6·8-9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0-8·0] vs 5·0 cm H2O [5·0-7·0]; p <0·0001). The prevalence of ARDS in patients at risk of ARDS was higher than in individuals not at risk of ARDS (19/260 [7%] vs 17/556 [3%]; p=0·004). Compared with individuals not at risk of ARDS, patients at risk of ARDS had higher in-hospital mortality (86/543 [16%] vs 74/232 [32%]; p <0·0001), ICU mortality (62/533 [12%] vs 66/227 [29%]; p <0·0001), and 90-day mortality (109/653 [17%] vs 88/282 [31%]; p <0·0001). VT did not differ between patients who did and did not develop ARDS (p=0·471 for those at risk of ARDS; p=0·323 for those not at risk). Around a third of patients receiving mechanical ventilation in the ICU were at risk of ARDS. Pulmonary complications occur frequently in patients at risk of ARDS and their clinical outcome is worse compared with those not at risk of ARDS. There is potential for improvement in the management of patients without ARDS. Further refinements are needed for prediction of ARDS. None
U2 - https://doi.org/10.1016/S2213-2600(16)30305-8
DO - https://doi.org/10.1016/S2213-2600(16)30305-8
M3 - Article
C2 - 27717861
SN - 2213-2600
VL - 4
SP - 882
EP - 893
JO - lancet. Respiratory medicine
JF - lancet. Respiratory medicine
IS - 11
ER -