National survey of outcomes and practices in acute respiratory distress syndrome in Singapore (original) (raw)
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Medicine, 2015
Most epidemiological studies of acute respiratory distress syndrome (ARDS) have been conducted in western countries, and studies in Asia are limited. The aim of our study was to evaluate the incidence, in-hospital mortality, and 1-year mortality of ARDS in Taiwan.We conducted a nationwide inpatient cohort study based on the Taiwan National Health Insurance Research Database between 1997 and 2011. A total of 40,876 ARDS patients (68% male; mean age 66 years) were identified by International Classification of Diseases, 9th edition coding and further analyzed for clinical characteristics, medical costs, and mortality.The overall crude incidence of ARDS was 15.74 per 100,000 person-years, and increased from 2.53 to 19.26 per 100,000 person-years during the study period. The age-adjusted incidence of ARDS was 15.19 per 100,000 person-years. The overall in-hospital mortality was 57.8%. In-hospital mortality decreased from 59.7% in 1997 to 47.5% in 2011 (P < 0.001). The in-hospital mort...
Journal of thoracic disease, 2018
Although acute respiratory distress syndrome (ARDS) has been recognized for more than 50 years, limited information exists about the incidence and management of ARDS in mainland China. To evaluate the potential for improvement in management of patients with ARDS, this study was designed to describe the incidence and management of ARDS in mainland China. National prospective multicenter observational study over one month (August 31 to September 30, 2012) of all patients who fulfilled the Berlin or American European Consensus Conference (AECC) definition of ARDS in 20 intensive care units, with data collection related to the management of ARDS, patient characteristics and outcomes. Of the 1,814 patients admitted during the enrollment period, 149 (8.2%) and 147 (8.1%) patients were diagnosed by AECC and Berlin definition, respectively. Lung protective strategy with low tidal volume (Vt) (≤8 mL/kg) and limitation of the plateau pressure (Pplat) (≤30 cmHO) was performed in 75.2% patients...
Acta medica Indonesiana, 2016
to identify the 28-day short-term survival rate in patients with acute respiratory distress syndrome (ARDS). this is a retrospective cohort study conducted at a tertiary referral hospital in Jakarta, Indonesia. We conducted the study for 10 months and data was extracted from medical records between October 2015 and August 2016. The primary end point of the study was 28-day short-term survival rate using the initial date of ARDS diagnosis as the index time. Overall survival rate was analyzed using Kaplan-Meier test and multivariate Cox regression analysis. there were 101 ARDS subjects during 10 months of study. The overall rate of 28-day survival was 47.5% and the median time of survival was 10 days (95% CI 2.47-17.52). The survival rate in ARDS patients was reduced significantly at the first week after the diagnosis of ARDS was made, which indicated that the highest mortality occured in the first week. Subjects with APACHE II score of >20 had a hazard ratio (HR) of 2.45 (95% CI ...
The International Epidemiology of Acute Respiratory Distress Syndrome
Critical Care Medicine, 2014
T he first syndromic definition of the acute respiratory distress syndrome (ARDS) (1) was created by Americans to recognize a serious condition with high mortality. The subsequent American European Consensus Conference (AECC) provided a uniform definition for the syndrome (2), facilitating paradigm-shifting clinical trials performed by ARDS Network (ARDSNet), funded by the National Heart, Lung and Blood Institute (3). The consensus definition also facilitated rigorous population-based studies estimating the prevalence of ARDS in the United States (4, 5). More recently, the ARDS Definition Task Force refined the syndrome with the Berlin Definition, providing variables on acuity, requirements for mechanical ventilation, and stratification of ARDS severity (6). The Berlin Definition came from an international consensus of researchers from industrialized nations in Europe, Australia, and North America and was based on studies from high-income countries. For ICU investigators from these nations, the ability and need to assess the impact of positive end-expiration pressures and gradations in arterial Poj/FiOj ratio reflect the ability of resource-laden healthcare systems to respond to critical illness. The members of the task force for the Berlin Definition do not address the challenges that may arise in low-income countries, such as availability of mechanical ventilation itself. In an international context, we read the study by Caser et al (7) in this issue of Critical Care Medicine, conducted in the urban region of Vitoria, Espirito Santo in Southeast Brazil. Brazil is an upper middle-income nation that is fifth in population and geography worldwide. A prior Brazilian *See also p. 574.
The Indian journal of medical research, 2016
Acute respiratory distress syndrome (ARDS) is a common disorder in critically ill patients and is associated with high mortality. There is a paucity of literature on this condition from developing countries. This prospective observational study was designed to find out the aetiology, outcomes and predictors of mortality in ARDS. Sixty four consecutive patients who satisfied American-European Consensus Conference (AECC) definition of ARDS from medical Intensive Care Unit (ICU) of a tertiary care centre in New Delhi, India, were enrolled in the study. Demographic, biochemical and ventilatory variables were recorded for each patient. Baseline measurements of serum interleukin (IL)-1β, IL-6, tumour necrosis factor-alpha (TNF-α), procalcitonin (PCT) and high sensitivity C-reactive protein (hsCRP) were performed. Common causes of ARDS included pneumonia [44/64 (68.7%)], malaria [9/64 (14.1%)] and sepsis [8/64 (12.5%]. Eight of the 64 (12.5%) patients had ARDS due to viral pneumonia. The 2...
PLOS ONE, 2019
Background The clinical epidemiology and disease prognosis in patients with acute respiratory distress syndrome (ARDS) have not yet been fully elucidated in Vietnam. Methods We conducted a retrospective observational study at a national tertiary hospital in Hanoi, Vietnam. Participants were adult patients (age �18 years) who were admitted and diagnosed with ARDS during 2015-2017. Data on patients' general and clinical conditions, radiographic findings, ventilator settings, gas exchange, and treatment methods were collected and compared between survivors and non-survivors. Risk factors for mortality were assessed using logistic regression analysis. Results Among 126 eligible patients with ARDS admitted to the central tertiary hospital in Vietnam, we observed high mortality (57.1%). Of the total patients, 91.3% were transferred from local hospitals with a diagnosis of severe pneumonia and then diagnosed with ARDS at the central hospital. At the time of admission, 53.2% of patients had severe ARDS, 37.3% had moderate ARDS, and 9.5% had mild ARDS. The mean (standard deviation) sequential organ failure assessment (SOFA) score was 9.5 (3.4) in non-survivors and 7.4 (3.4) in survivors (p = 0.002). Although there was no significant difference in PaO 2 /FiO 2 on admission between nonsurvivors and survivors, that on day 3 after admission was significantly different (p = 0.002). Logistic regression revealed that PaO 2 /FiO 2 on day 3 [odds ratio (OR), 1.010; 95% confidence
American Journal of Respiratory and Critical Care Medicine, 2016
Rationale: Estimates of the incidence of the acute respiratory distress syndrome (ARDS) in high-and middle-income countries vary from 10.1 to 86.2 per 100,000 person-years in the general population. The epidemiology of ARDS has not been reported for a low-income country at the level of the population, hospital, or intensive care unit (ICU). The Berlin definition may not allow identification of ARDS in resource-constrained settings. Objectives: To estimate the incidence and outcomes of ARDS at a Rwandan referral hospital using the Kigali modification of the Berlin definition: without requirement for positive endexpiratory pressure, hypoxia cutoff of Sp O 2 /FI O 2 less than or equal to 315, and bilateral opacities on lung ultrasound or chest radiograph. Methods: We screened every adult patient for hypoxia at a public referral hospital in Rwanda for 6 weeks. For every patient with hypoxia, we collected data on demographics and ARDS risk factors, performed lung ultrasonography, and evaluated chest radiography when available. Measurements and Main Results: Forty-two (4.0%) of 1,046 hospital admissions met criteria for ARDS. Using various prespecified cutoffs for the Sp O 2 /FI O 2 ratio resulted in almost identical hospital incidence values. Median age for patients with ARDS was 37 years, and infection was the most common risk factor (44.1%). Only 30.9% of patients with ARDS were admitted to an ICU, and hospital mortality was 50.0%. Using traditional Berlin criteria, no patients would have met criteria for ARDS. Conclusions: ARDS seems to be a common and fatal syndrome in a hospital in Rwanda, with few patients admitted to an ICU. The Berlin definition is likely to underestimate the impact of ARDS in low-income countries, where resources to meet the definition requirements are lacking. Although the Kigali modification requires validation before widespread use, we hope this study stimulates further work in refining an ARDS definition that can be consistently used in all settings.
Clinical outcomes of acute respiratory distress syndrome in a university hospital
Asian Biomedicine
Background Mortality rates of acute respiratory distress syndrome (ARDS) are different, depending on severity, etiology, and management. Objective To determine 7-day and 28-day mortalities, hospital length of stay (LOS), duration of mechanical ventilation (MV) of ARDS patients, and factors associated with poor outcomes. Methods A retrospective study was conducted to review the database of ARDS patients admitted in medical intensive care units (ICUs) at a university hospital between 2010 and 2014. The cases were identified by using International Classification of Diseases, 10th Revision (ICD-10) code-J80 ARDS. Results Of 266 patients, 11.7%, 44.4%, and 44% fulfilled mild, moderate, and severe ARDS criteria, respectively. The main cause of ARDS was pneumonia. The 7-day and 28-day mortalities, median LOS, and median MV duration were 31.1%, 69.3%, 18, and 11 days, respectively. Pressure control was the most favorite mode, used with average tidal volume (TV) of 8.63 (2.16) mL/kg ideal bo...