COMMENTARY

Global Patterns of ARDS Treatment

Greg Martin, MD

Disclosures

June 17, 2016

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Bellani G, Laffey JG, Pham T, et al; LUNG SAFE Investigators; ESICM Trials Group
JAMA. 2016;23;315:788-800

Summary

Acute respiratory distress syndrome (ARDS) is a form of acute inflammatory lung injury, most often due to sepsis, severe trauma, aspiration, pancreatitis, and other systemic injuries and inflammatory disorders.[1] It is defined by hypoxemic respiratory failure.

Few studies have been completed to characterize the epidemiology of ARDS.[2,3] Bellani and colleagues designed and conducted the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) as an international, multicenter, prospective study of patients receiving invasive or noninvasive ventilation, conducted during 4 consecutive weeks in winter 2014 in 459 intensive care units (ICUs) from 50 countries across five continents. They identified 29,144 ICU patients, of whom 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and had their respiratory failure managed with invasive mechanical ventilation.

By severity, ARDS was categorized as mild in 30.0% of patients, moderate in 46.6%, and severe in 23.4%. ARDS occurred in 10.4% of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% in mild ARDS to 78.5% in severe ARDS. Hospital mortality was 34.9% for patients with mild ARDS, 40.3% for those with moderate ARDS, and 46.1% for those with severe ARDS.

The authors concluded that among critically ill patients in 50 countries, the prevalence of ARDS is 10.4% and ARDS is associated with a high mortality rate.

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