1. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study
- Author
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Neto, A, Barbas, C, Simonis, F, Artigas-Raventos, A, Canet, J, Determann, R, Anstey, J, Hedenstierna, G, Hemmes, S, Hermans, G, Hiesmayr, M, Hollmann, M, Jaber, S, Martin-Loeches, I, Mills, G, Pearse, R, Putensen, C, Schmid, W, Severgnini, P, Smith, R, Treschan, T, Tschernko, E, Melo, M, Wrigge, H, de Abreu, M, Pelosi, P, Schultz, M, Russotto, V, Neto, AS, Barbas, CSV, Simonis, FD, Determann, RM, Hemmes, SNT, Hollmann, MW, Mills, GH, Pearse, RM, Treschan, TA, Tschernko, EM, Melo, MFV, de Abreu, MG, Schultz, MJ, Neto, A, Barbas, C, Simonis, F, Artigas-Raventos, A, Canet, J, Determann, R, Anstey, J, Hedenstierna, G, Hemmes, S, Hermans, G, Hiesmayr, M, Hollmann, M, Jaber, S, Martin-Loeches, I, Mills, G, Pearse, R, Putensen, C, Schmid, W, Severgnini, P, Smith, R, Treschan, T, Tschernko, E, Melo, M, Wrigge, H, de Abreu, M, Pelosi, P, Schultz, M, Russotto, V, Neto, AS, Barbas, CSV, Simonis, FD, Determann, RM, Hemmes, SNT, Hollmann, MW, Mills, GH, Pearse, RM, Treschan, TA, Tschernko, EM, Melo, MFV, de Abreu, MG, and Schultz, MJ
- Abstract
Background Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. Methods PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed. Findings Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27–33), representing 0·14 cases per ICU bed over a 1-week period. VT was similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7–9·1] vs 7·9 mL/kg PBW [6·8–9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0–8·0] vs 5·0 cm H2O [5·0–7·0]; p<0·0001). The prevalence of ARDS in patients at risk of ARDS was higher than in individuals
- Published
- 2016