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

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, CHARDSnet group, Lixin Xie, Ying Wang, Li Weng, Guangfa Zhu, Yan Liu, Man Song, Yanming Zhao, Jing Chen, Hongwen Zhao, Haijia Hou, Jingping Yang, Rina Wu, Xiyuan Xu, Xixin Yan, Haibo Xu, Dawei Wu, Haining Lu, Gengyun Sun, Dan Zhang, Beilei Zhao, Binhai Pan, Jialin Liu, Ruoming Tan, Pinhua Pan, Rongli Lu, Hong Luo, Han Zhang, Daoxin Wang, Wang Deng, Yusheng Chen, Fengfeng Lu, Sicheng Xu, Xia Luo, Hong Teng, Lijuan Chen, Lihua Xing, Shilei Wang, Tongwen Sun, Shaohua Liu, Bing Han, Yunlu Li, 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, CHARDSnet group, Lixin Xie, Ying Wang, Li Weng, Guangfa Zhu, Yan Liu, Man Song, Yanming Zhao, Jing Chen, Hongwen Zhao, Haijia Hou, Jingping Yang, Rina Wu, Xiyuan Xu, Xixin Yan, Haibo Xu, Dawei Wu, Haining Lu, Gengyun Sun, Dan Zhang, Beilei Zhao, Binhai Pan, Jialin Liu, Ruoming Tan, Pinhua Pan, Rongli Lu, Hong Luo, Han Zhang, Daoxin Wang, Wang Deng, Yusheng Chen, Fengfeng Lu, Sicheng Xu, Xia Luo, Hong Teng, Lijuan Chen, Lihua Xing, Shilei Wang, Tongwen Sun, Shaohua Liu, Bing Han, Yunlu Li

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.

Keywords: Acute respiratory distress syndrome (ARDS); Diagnosis; Incidence; Lung protective mechanical ventilation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow of patient screening and enrollment
Fig. 2
Fig. 2
Incidences of ARDS in different ICUs. The incidences of ARDS varied among different ICUs, with the highest incidence of 16.7% in China-Japan Friendship Hospital and the lowest incidence of 1.0% in the First Affiliated Hospital of Anhui Medical University
Fig. 3
Fig. 3
Probability of hospital survival by ARDS severity. Survival curve showed a lower likelihood of survival in severe group compared with mild and moderate groups on day 1

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