1. The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era
- Author
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Jesús Villar, MD, PhD, FCCM, Juan M. Mora-Ordoñez, MD, Juan A. Soler, MD, PhD, Fernando Mosteiro, MD, PhD, Anxela Vidal, MD, Alfonso Ambrós, MD, PhD, Lorena Fernández, MD, Isabel Murcia, MD, Belén Civantos, MD, Miguel A. Romera, MD, Adrián Mira, MD, Francisco J. Díaz-Domínguez, MD, Dácil Parrilla, MD, J. Francisco Martínez-Carmona, MD, Domingo Martínez, MD, Lidia Pita-García, MD, Denis Robaglia, MD, Ana Bueno-González, MD, Jesús Sánchez-Ballesteros, MD, Ángel E. Pereyra, MD, Mónica Hernández, MD, Carlos Chamorro-Jambrina, MD, Pilar Cobeta, MD, Raúl I. González-Luengo, MD, Raquel Montiel, MD, Leonor Nogales, MD, M. Mar Fernández, MD, PhD, Blanca Arocas, MD, Álvaro Valverde-Montoro, MD, Ana M. del Saz-Ortiz, MD, Victoria Olea-Jiménez, MD, José M. Añón, MD, PhD, Pedro Rodríguez-Suárez, MD, Rosa L. Fernández, MSc, Cristina Fernández, MSc, Tamas Szakmany, MD, PhD, Jesús M. González-Martín, PhD, Carlos Ferrando, MD, PhD, Robert M. Kacmarek, PhD, RTT, Arthur S. Slutsky, MD, for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) Network, José M. Añón, Belén Civantos, Mónica Hernández, Elena González, Rosario Solano, F. Javier Díaz-Domínguez, Demetrio Carriedo, Raul I. González Luengo, Carlos Ferrando, Blanca Arocas, Javier Belda, Marina Soro, Gerardo Aguilar, Ernesto Pastor, Lorena Fernández, Jesús Sánchez-Ballesteros, Arturo Muriel, Pablo Blanco-Schweizer, José Ángel de Ayala, Jesús Blanco, César Aldecoa, Alba Pérez, Jesús Rico-Feijoo, Leonor Nogales, David Andaluz, Laura Parra, Juan A. Soler, Domingo Martínez, Ana M. del Saz-Ortiz, Alfonso Ambrós, Ana Bueno-González, Carmen Hornos-López, Raquel Montiel, Dácil Parrilla, Eduardo Peinado, Isidro Prieto, Mario Chico, Miguel A. Romera, Carlos Chamorro-Jambrina, Juan M. Mora-Ordoñez, J. Francisco Martínez-Carmona, Álvaro Valverde-Montoro, Victoria Olea-Jiménez, Paco Alba, Ruth Corpas, Fernando Mosteiro, Lidia Pita-García, Eleuterio Merayo, Chanel Martínez, Ángeles de Célis-Álvarez, Carmen Martín-Delgado, Adrián Mira, Pilar Cobeta, David Pestaña, María del Mar Fernández, Concepción Tarancón, Silvia Cortés-Díaz, Anxela Vidal, Denis Robaglia, César Pérez, Isabel Murcia, Ángel E. Pereyra-Pache, Tamas Szakmany, Jesús Villar, Rosa L. Fernández, Cristina Fernández, Pedro Rodríguez-Pérez, Jesús M. González-Martín, Robert M. Kacmarek, and Arthur S. Slutsky
- Subjects
Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
OBJECTIVES:. To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN:. A 6-month prospective, epidemiological, observational study. SETTING:. A network of 22 multidisciplinary ICUs in Spain. PATIENTS:. Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837). CONCLUSIONS:. AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.
- Published
- 2022
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