TY - JOUR
T1 - Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ)
T2 - An observational study
AU - Parke, Rachael L.
AU - McGuinness, Shay P.
AU - Cavadino, Alana
AU - Cowdrey, Keri Anne
AU - Bates, Samantha
AU - Bihari, Shailesh
AU - Corley, Amanda
AU - Gilder, Eileen
AU - Hodgson, Carol
AU - Litton, Edward
AU - McArthur, Colin
AU - Nichol, Alistair
AU - Parker, Jane
AU - Turner, Anne
AU - Webb, Steve
AU - Van Haren, Frank MP
AU - on behalf of the SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group
N1 - Funding Information:
This study received funding in the form of a Faculty Research Development Fund New Staff grant, The University of Auckland (Project number 3719322) and from the College of Health and Medicine, Australian National University (crisis research seed funding). Funders had no input into study design, analysis, or reporting.
Publisher Copyright:
© 2024 The Authors
PY - 2024/9
Y1 - 2024/9
N2 - Objective: Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice. Design: Bi-national, prospective, observational, multi-centre study. Setting: 19 ICUs in Australia and New Zealand. Participants: Mechanically ventilated patients with moderate-severe ARDS. Main outcome measures: Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics. Results: 200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO2/FiO2 ratio 119 (89, 142), median (IQR) FiO2 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH2O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H2O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61). Conclusions: In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.
AB - Objective: Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice. Design: Bi-national, prospective, observational, multi-centre study. Setting: 19 ICUs in Australia and New Zealand. Participants: Mechanically ventilated patients with moderate-severe ARDS. Main outcome measures: Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics. Results: 200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO2/FiO2 ratio 119 (89, 142), median (IQR) FiO2 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH2O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H2O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61). Conclusions: In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.
KW - Acute respiratory distress syndrome: adjunctive therapy
KW - Lung protective ventilation
KW - Mechanical ventilation
KW - Prone positioning
UR - http://www.scopus.com/inward/record.url?scp=85196505173&partnerID=8YFLogxK
U2 - 10.1016/j.ccrj.2024.05.001
DO - 10.1016/j.ccrj.2024.05.001
M3 - Article
C2 - 39355498
AN - SCOPUS:85196505173
SN - 1441-2772
VL - 26
SP - 161
EP - 168
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 3
ER -