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.
Highlights
Worldwide over 100 million patients are ventilated annually, mostly in operating theatres, with about 10 million ventilated in intensive care units (ICU)
A total of 22.2% of patients admitted for mechanical ventilation developed acute hypoxaemic respiratory failure (AHRF), which was associated with a significant mortality rate of 35.5%, similar to other European studies [1,9]
AHRF appears to be common in the ICUs [10,11], affecting almost a quarter of those needing mechanical ventilation
Summary
Worldwide over 100 million patients are ventilated annually, mostly in operating theatres, with about 10 million ventilated in intensive care units (ICU). It is estimated that approximately one million patients develop acute hypoxemic respiratory failure (AHRF), data on the exact prevalence and outcomes of this condition are sparse [1,2]. There are some previously published observational studies examining the incidence and mortality of patients with AHRF and ARDS, there are no studies assessing the epidemiological characteristics, patterns of ventilation and clinical outcomes in patients with acute hypoxemic respiratory failure in the current era of lung protective ventilation [2,6,7]. We aimed to identify the prevalence of acute hypoxaemic respiratory failure (AHRF) in the intensive care unit (ICU) and its associated mortality. 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. Despite advances of care and better, but not optimal, utilisation of low tidal volume ventilation, mortality remains high
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