Rachael L. Parke RN, PhD , Shay P. McGuinness MBChB , Alana Cavadino PhD , Keri-Anne Cowdrey RN, MN , Samantha Bates RN, MN , Shailesh Bihari MBBS, PhD , Amanda Corley RN, PhD , Eileen Gilder RN, PhD , Carol Hodgson PhD , Edward Litton MBChB, PhD , Colin McArthur MBChB , Alistair Nichol MBBCh, PhD , Jane Parker RN, MPH , Anne Turner RN, MPH , Steve Webb MBBS, PhD , Frank MP. Van Haren MD, PhD , SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group
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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.</p></div><div><h3>Design</h3><p>Bi-national, prospective, observational, multi-centre study.</p></div><div><h3>Setting</h3><p>19 ICUs in Australia and New Zealand.</p></div><div><h3>Participants</h3><p>Mechanically ventilated patients with moderate-severe ARDS.</p></div><div><h3>Main outcome measures</h3><p>Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.</p></div><div><h3>Results</h3><p>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) PaO<sub>2</sub>/FiO<sub>2</sub> ratio 119 (89, 142), median (IQR) FiO<sub>2</sub> 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH<sub>2</sub>O. 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 H<sub>2</sub>O). 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).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":49215,"journal":{"name":"Critical Care and Resuscitation","volume":"26 3","pages":"Pages 161-168"},"PeriodicalIF":1.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1441277224000139/pdfft?md5=d534b9440be94c4ac8edd575b084a64d&pid=1-s2.0-S1441277224000139-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study\",\"authors\":\"Rachael L. Parke RN, PhD , Shay P. 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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.</p></div><div><h3>Design</h3><p>Bi-national, prospective, observational, multi-centre study.</p></div><div><h3>Setting</h3><p>19 ICUs in Australia and New Zealand.</p></div><div><h3>Participants</h3><p>Mechanically ventilated patients with moderate-severe ARDS.</p></div><div><h3>Main outcome measures</h3><p>Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.</p></div><div><h3>Results</h3><p>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) PaO<sub>2</sub>/FiO<sub>2</sub> ratio 119 (89, 142), median (IQR) FiO<sub>2</sub> 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH<sub>2</sub>O. 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 H<sub>2</sub>O). 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).</p></div><div><h3>Conclusions</h3><p>In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. 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Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study
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.
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.
期刊介绍：
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.
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