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RESEARCH PRODUCT

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

Ary Serpa NetoCarmen S V BarbasFabienne D SimonisAntonio Artigas-raventósJaume CanetRogier M DetermannJames AnsteyGoran HedenstiernaSabrine N T HemmesGreet HermansMichael HiesmayrMarkus W HollmannSamir JaberIgnacio Martin-loechesGary H MillsRupert PearseChristian PutensenWerner SchmidPaolo SevergniniRoger SmithTanja A TreschanEdda M TschernkoMarcos F V MeloHermann WriggeMarcelo Gama De AbreuPaolo PelosiMarcus J SchultzAdam BellAgreta Gecaj-gashiAhmet DilekAhmet Sukru DenkerAkut AytulunPeter KienbaumAlastair RoseAlessandro BacuzziAlexandre Biasi CavalcantiAlexandre ChanAlexandre MolinAlison GhoshAlistair RoyAmanda CowtonAmanda SkinnerAmanda WhilemanAmy McinerneyAna Carolina PeçanhaAndrea CortegianiAndrej SribarAndrew BentleyAndrew CornerAngela PinderAnil HormisAnna WalkerAntonio Artigas-raventósAry Serpa NetoBarry DixonBen Creagh-brownCarlo Alberto VoltaCarlos MunhozCarly BrownCarmen S V BarbasCarmen ScottCaroline WreybrownCatherine PlowrightCharlotte DownesCheryl Padilla-harrisChloe HughesChristian FreyChristian PutensenChristian SchlegelChristine BoydChristine RyanChristoph MuenchChristopher SmalleyÇIler ZincirciogluClair HarrisClaire KalooClaire MatthewsClaire MillerClaire PeggClare BullockClare MellisClaudio PirasColette SeasmanCristina SantosDaniel BeraldoDaniel CollinsDaniel HadfieldDaniel HullDaniel PradoDavid PogsonDavid RogersonDavid ShawDavide D'antiniDawn Trodd Denise GriffinDebbie WellerDeborah SmithDeborah WilsonDemet AydinDenise DonaldsonDonatella MestriaEdda M TschernkoEduardo Di LauroEliane Bernadete CaserElisa SegheliniEmanuel CirsteaEoin YoungErna AlbertsEvren SenturkFabienne D SimonisFarooq BrohiFatma UlgerFeda KahveciFernando José Da Silva RamosFrank Van HarenGüldem TuranGabriele SalesGary H MillsGary H MillsGayle CliffordGilda CinnellaGiovana Colozza MecattiGiuseppe MelchiondaGoran HedenstiernaGreet HermansGreet HermansGulay ErenHannah CrowtherHazel SpencerHeather BlaylockHelen GreenHelen RobertsonHelen RodgersHelen TalbotHelen WongHelena Barcraft-barnesHelga CeunenHenrik ReschreiterHermann WriggeHermann WriggeHulya UlusoyHuseyin TomanIain MccullaghIan WhiteIgnacio Martin-loechesIngeborg WeltersIngrid Van Den HulIsabela Ambrósio GavaIsabelle ReedIsil KoseIsrael MaiaJames LimbJan MácaJane AdderlyJane HuntJane MartinJane MontgomeryJane SnellJaume CanetJean SalgadoJenny RitzemaJeremy BewleyJoanne HoweJohan DecruyenaereJohanna MoulandJohanna StickleyJohannes MellinghoffJohn CriswellJohn KnightonJonathan CooperJonathan HarrisonJonathan PaddleJose Augusto Santos PellegriniJoseph NeedlemanJulian GilesJulie CamsooksaiJulie FurnevalJulie TomsKaren BurtKaren SimesonKaren WilliamsKarl BlenkKate TurnerKatie LynchKatie SweetKeith HugillKelly MatthewsKessia RuasKevin ClarksonKobus PrellerKristen JoyceLaura Ortiz-ruizLaura YoudsLee TbailyLisa BarrellLisa GrimmerLokman SoyoralLorenzo PelusoLorna MurrayLotta NiskaLouise TonksLousie FastingLuc DecropLuca BrazziLucia MirabellaLucy CooperLuis Fernando FalcãoLynn EverettMalcolm WattersMandy CarnahanMarc BourgeoisMarcelo Gama De AbreuMarcelo Luz Pereira RomanoMarco BotteriMarcos F Vidal MeloMarcos F Vidal MeloMarcus J SchultzMarcus J SchultzMaria FaulknerMarijana KrkusekMarina BahlMark HollidayMark KolMark PulletzMarkus W HollmannMarta KozlowskiMatea Bogdanovic DvorscakMatija JurjevicMatty KoopmansMauricio MoralesMaximilian S. SchaeferMelinda BrazierMeredith HarrisMichael DevileMichael HiesmayrMichael KuiperMichael ParrisMichael SharmanMilan KratochvilMohamed RamaliMoreno Calcagnotto Dos SantosNatalie BynorthNatalie WilsonNathalie AnquezNathan HunekeNazim DoganNenad KaranovicNicholas TarmeyNicolás CarreñoNicola FisherNicola LambNicola VennerNigel HollisterNur AkgunOsman EkinciOwen BoydPaolo PelosiPaolo PelosiPaolo SevergniniPaolo SevergniniPardeep GillPasquale RaimondoPasquale VerrastroPaul PulakPauline FitzellPaulo DarkPedro AlzugarayPerihan Ergin ÖZcanPeter MacnaughtonPetr StouracPhil HopkinsPieter Roel TuinmanRachel PearsonRachel WalkerRafaella Souza Dos SantosRaffaele CaioneRamprasad MatsaRebecca OliverReni JacobRichard Howard-griffinRobert Bp De WildeRobert PlantRobin HollandsRodrigo BiondiRoger SmithRoger SmithRogier M DetermannRola JaafarRossana AvendañoRupert M PearseRuth SaltRyan HumphriesSérgio Felix PintoSabrine N T HemmesSallyane PearsonSam HendrySamir JaberSandeep LakhaniSarah BeavisSarah MoretonSarah PruddenSarah ThornthwaiteSavino SpadaroSedat SaylanShailaja ChennaShammer GopalShanaz JamesSheeba SureshSian BirchSonja SkilijicStefania AguirreStella MetherellStephanie BellStephanie JanesStephen WrightSteve RoseSteve WindebankSue GlennSusan MelbourneSusan TysonSusannah LeaverTanja A TreschanTanja A TreschanTasmin PatelTatjana SimurinaTerri-ann SewellTiago MacruzTom HattonTracey EvansUgur GoktasUna PoultneyUnase BuyukkocakVanessa LinnettVanessa OliveiraVincenzo RussottoVlasta KlaricWerner SchmidYavuz OrakZerrin Demirtürk

subject

MalePediatricsARDSmedicine.medical_treatmentlaw.inventionPositive-Pressure Respiration0302 clinical medicinelawRisk FactorsPrevalenceventilator–induced lung injuryProspective StudiesHospital MortalityProspective cohort studyTidal volumeeducation.field_of_studyRespiratory Distress SyndromeAcute respiratory distress syndrometidal volumeARDS critically ill ventilationMiddle AgedIntensive care unitIntensive Care UnitsCritical IllneFemaleHumanPulmonary and Respiratory Medicinemedicine.medical_specialtyCritical IllnessPopulationIntensive Care UnitLung injurymechanical ventilationNO03 medical and health sciencesIntensive caremedicineAcute respiratory distress syndrome mechanical ventilation ventilator–induced lung injury tidal volume positive end–expiratory pressureHumansMED/41 - ANESTESIOLOGIAeducationAgedMechanical ventilationbusiness.industryRisk FactorRespiratory Distress Syndrome Adult030208 emergency & critical care medicinemedicine.diseaseRespiration ArtificialMechanical ventilation Acute respiratory failure Acute respiratory distress syndromeProspective Studie030228 respiratory systemEmergency medicinepositive end–expiratory pressurebusiness

description

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. VTwas 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 not at risk of ARDS (19/260 [7%] vs 17/556 [3%]; p=0·004). Compared with individuals not at risk of ARDS, patients at risk of ARDS had higher in-hospital mortality (86/543 [16%] vs 74/232 [32%]; p<0·0001), ICU mortality (62/533 [12%] vs 66/227 [29%]; p<0·0001), and 90-day mortality (109/653 [17%] vs 88/282 [31%]; p<0·0001). VTdid not differ between patients who did and did not develop ARDS (p=0·471 for those at risk of ARDS; p=0·323 for those not at risk). Interpretation Around a third of patients receiving mechanical ventilation in the ICU were at risk of ARDS. Pulmonary complications occur frequently in patients at risk of ARDS and their clinical outcome is worse compared with those not at risk of ARDS. There is potential for improvement in the management of patients without ARDS. Further refinements are needed for prediction of ARDS. Funding None.

yearjournalcountryeditionlanguage
2016-11-01
10.1016/s2213-2600(16)30305-8http://hdl.handle.net/11392/2374024