Prevalence and Outcomes of Acute Hypoxaemic Respiratory Failure in Wales: The PANDORA-WALES Study

Maja Kopczynska, Ben Sharif, Richard Pugh, Igor Otahal, Peter Havalda, Wojciech Groblewski, Ceri Lynch, David George, Jayne Sutherland, Manish Pandey, Phillippa Jones, Maxene Murdoch, Adam Hatalyak, Rhidian Jones, Robert M Kacmarek, Jesús Villar, Tamas Szakmany, On Behalf Of The Pandora-Wales Investigators, Maja Kopczynska, Ben Sharif, Richard Pugh, Igor Otahal, Peter Havalda, Wojciech Groblewski, Ceri Lynch, David George, Jayne Sutherland, Manish Pandey, Phillippa Jones, Maxene Murdoch, Adam Hatalyak, Rhidian Jones, Robert M Kacmarek, Jesús Villar, Tamas Szakmany, On Behalf Of The Pandora-Wales Investigators

Abstract

Background: We aimed to identify the prevalence of acute hypoxaemic respiratory failure (AHRF) in the intensive care unit (ICU) and its associated mortality. The secondary aim was to describe ventilatory management as well as the use of rescue therapies.

Methods: Multi-centre prospective study in nine hospitals in Wales, UK, over 2-month periods. All patients admitted to an ICU were screened for AHRF and followed-up until discharge from the ICU. Data were collected from patient charts on patient demographics, clinical characteristics, management and outcomes.

Results: Out of 2215 critical care admissions, 886 patients received mechanical ventilation. A total of 197 patients met inclusion criteria and were recruited. Seventy (35.5%) were non-survivors. Non-survivors were significantly older, had higher SOFA scores and received more vasopressor support than survivors. Twenty-five (12.7%) patients who fulfilled the Berlin definition of acute respiratory distress syndrome (ARDS) during the ICU stay without impact on overall survival. Rescue therapies were rarely used. Analysis of ventilation showed that median Vt was 7.1 mL/kg PBW (IQR 5.9-9.1) and 21.3% of patients had optimal ventilation during their ICU stay.

Conclusions: One in four mechanically ventilated patients have AHRF. Despite advances of care and better, but not optimal, utilisation of low tidal volume ventilation, mortality remains high.

Keywords: rescue therapies; respiratory failure; survival; ventilation.

Conflict of interest statement

R.M.K. serves as a consultant for Medtronic and Orange Med Inc., and received research grants from Medtronic and Orange Med Inc and provided a web seminar on High Flow Nasal Cannulas and Ventilator Management of the Obese Patient for Nihon Kohden. J.V. received a research grant from Maquet.

Figures

Figure 1
Figure 1
Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in Wales (PANDORA-WALES) recruitment flow chart and eventual study sample. Mechanically ventilated patients who fulfilled study criteria of PaO2/FiO2 ≤ 300 mmHg on invasive mechanical ventilation with a Positive End-Expiratory Pressure (PEEP) of 5 cm H2O or more, and with a FiO2 of 0.3 or more were included in the study. All other patients were ineligible.
Figure 2
Figure 2
(A) VT measurements during the whole ICU stay. (B) PEEP measurements during the whole ICU stay. Absolute numbers are shown above the bars.

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