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Critical Care
Published in: Critical Care 1/2020

Open Access 01-12-2020 | Care | Research

Incidence and outcomes of acute respiratory distress syndrome in intensive care units of mainland China: a multicentre prospective longitudinal study

Authors: Xu Huang, Ruoyang Zhang, Guohui Fan, Dawei Wu, Haining Lu, Daoxin Wang, Wang Deng, Tongwen Sun, Lihua Xing, Shaohua Liu, Shilei Wang, Ying Cai, Ye Tian, Yi Zhang, Jingen Xia, Qingyuan Zhan, the CHARDSnet group

Published in: Critical Care | Issue 1/2020

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Abstract

Objectives

To evaluate the incidence and mortality of acute respiratory distress syndrome (ARDS) in medical/respiratory intensive care units (MICUs/RICUs) to assess ventilation management and the use of adjunct therapy in routine clinical practice for patients fulfilling the Berlin definition of ARDS in mainland China.

Methods

This was a multicentre prospective longitudinal study. Patients who met the Berlin definition of ARDS were included. Baseline data and data on ventilator management and the use of adjunct therapy were collected.

Results

Of the 18,793 patients admitted to participating ICUs during the study timeframe, 672 patients fulfilled the Berlin ARDS criteria and 527 patients were included in the analysis. The most common predisposing factor for ARDS in 402 (77.0) patients was pneumonia. The prevalence rates were 9.7% (51/527) for mild ARDS, 47.4% (250/527) for moderate ARDS, and 42.9% (226/527) for severe ARDS. In total, 400 (75.9%) patients were managed with invasive mechanical ventilation during their ICU stays. All ARDS patients received a tidal volume of 6.8 (5.8–7.9) mL/kg of their predicted body weight and a positive end-expository pressure (PEEP) of 8 (6–12) cmH2O. Recruitment manoeuvres (RMs) and prone positioning were used in 61 (15.3%) and 85 (16.1%) ventilated patients, respectively. Life-sustaining care was withdrawn from 92 (17.5%) patients. When these patients were included in the mortality analysis, 244 (46.3%) ARDS patients (16 (31.4%) with mild ARDS, 101 (40.4%) with moderate ARDS, and 127 (56.2%) with severe ARDS) died in the hospital.

Conclusions

Among the 18 ICUs in mainland China, the incidence of ARDS was low. The rates of mortality and withdrawal of life-sustaining care were high. The recommended lung protective strategy was followed with a high degree of compliance, but the implementation of adjunct treatment was lacking. These findings indicate the potential for improvement in the management of patients with ARDS in China.

Trial registration

Clinicaltrials.gov NCT02975908. Registered on 29 November 2016—retrospectively registered.
Appendix
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Metadata
Title
Incidence and outcomes of acute respiratory distress syndrome in intensive care units of mainland China: a multicentre prospective longitudinal study
Authors
Xu Huang
Ruoyang Zhang
Guohui Fan
Dawei Wu
Haining Lu
Daoxin Wang
Wang Deng
Tongwen Sun
Lihua Xing
Shaohua Liu
Shilei Wang
Ying Cai
Ye Tian
Yi Zhang
Jingen Xia
Qingyuan Zhan
the CHARDSnet group
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03112-0

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