BackgroundClinical and epidemiological differences between acute respiratory distress syndrome (ARDS) that presents at the initiation of mechanical ventilation [MV] (ARDS at MV onset) and that which develops during the course of MV (ARDS after MV onset) are not well understood. We conducted an observational study in five Peruvian ICUs to characterize differences between ARDS at MV onset and after MV onset and identify risk factors for the development of ARDS after MV onset.MethodsWe consecutively enrolled critically ill patients with acute respiratory failure requiring at least 24 h of mechanical ventilation and followed them prospectively during the first 28 days and compared baseline characteristics and clinical outcomes by ARDS status.ResultsWe enrolled 1657 participants on MV (mean age 60.0 years, 55% males) of whom 334 (20.2%) had ARDS at MV onset and 180 (10.9%) developed ARDS after MV onset. Average tidal volume at the initiation of MV was 8.7 mL/kg of predicted body weight (PBW) for participants with ARDS at MV onset, 8.6 mL/kg PBW for those who developed ARDS after MV onset, and 8.5 mL/kg PBW for those who never developed ARDS (p = 0.23). Overall, 90-day mortality was 56% and 55% for ARDS after MV onset and ARDS at MV onset, respectively, as compared to 46% among those who never developed ARDS (p < 0.01). Adults with ARDS had a higher body mass index (BMI) than those without ARDS (27.3 vs 26.5 kg/m2, p < 0.01). Higher peak pressure (adjusted interquartile OR = 1.51, 95% CI 1.21–1.88), higher mean airway pressure (adjusted interquartile OR = 1.41, 95% CI 1.13–1.76), and higher positive end-expiratory pressure (adjusted interquartile OR = 1.29, 95% CI 1.10–1.50) at MV onset were associated with a higher odds of developing ARDS after MV onset.ConclusionsIn this study of mechanically ventilated patients, 31% of study participants had ARDS at some point during their ICU stay. Optimal lung-protective ventilation was not used in a majority of patients. Patients with ARDS after MV onset had a similar 90-day mortality as those with ARDS at MV onset. Higher airway pressures at MV onset, higher PEEP, and higher BMI were associated with the development of ARDS after MV onset.

中文翻译：

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秘鲁机械通气成人发生急性呼吸窘迫综合征的危险因素：一项多中心观察性研究

背景 在机械通气 [MV] 开始时出现的急性呼吸窘迫综合征 (ARDS)（在 MV 开始时出现 ARDS）与在 MV 过程中发生的急性呼吸窘迫综合征 (ARDS) 之间的临床和流行病学差异（在 MV 开始后出现 ARDS）尚不清楚。我们在五个秘鲁 ICU 进行了一项观察性研究，以表征 MV 发作时和 MV 发作后 ARDS 之间的差异，并确定 MV 发作后发生 ARDS 的危险因素。机械通气并在前 28 天内前瞻性地跟踪他们，并根据 ARDS 状态比较基线特征和临床结果。结果我们招募了 1657 名 MV 参与者（平均年龄 60.0 岁，55% 为男性），其中 334 名（20. 2%) 在 MV 发作时患有 ARDS，180 (10.9%) 在 MV 发作后发展为 ARDS。MV 开始时的平均潮气量为 8.7 mL/kg 预测体重 (PBW)，其中 ARDS 参与者在 MV 发作时为 8.6 mL/kg PBW，MV 发作后发生 ARDS 的参与者为 8.6 mL/kg PBW，而那些参与者为 8.5 mL/kg PBW谁从未患上 ARDS（p = 0.23）。总体而言，MV 发作后 ARDS 和 MV 发作时 ARDS 的 90 天死亡率分别为 56% 和 55%，而从未发生 ARDS 的患者为 46%（p < 0.01）。ARDS 成人的体重指数 (BMI) 高于非 ARDS 成人（27.3 与 26.5 kg/m2，p < 0.01）。更高的峰值压力（调整后的四分位间距 OR = 1.51，95% CI 1.21-1.88）、更高的平均气道压力（调整后的四分位间距 OR = 1.41、95% CI 1.13-1.76）和更高的呼气末正压（调整后的四分位间距 OR = 12）。 , 95% CI 1.10–1。50) 在 MV 发作时与 MV 发作后发生 ARDS 的几率更高有关。结论在这项机械通气患者的研究中，31% 的研究参与者在他们入住 ICU 期间的某个时间点患有 ARDS。大多数患者未使用最佳肺保护通气。MV 发作后 ARDS 患者的 90 天死亡率与 MV 发作时 ARDS 患者相似。MV 发作时较高的气道压力、较高的 PEEP 和较高的 BMI 与 MV 发作后发生 ARDS 相关。MV 发作后 ARDS 患者的 90 天死亡率与 MV 发作时 ARDS 患者相似。MV 发作时较高的气道压力、较高的 PEEP 和较高的 BMI 与 MV 发作后发生 ARDS 相关。MV 发作后 ARDS 患者的 90 天死亡率与 MV 发作时 ARDS 患者相似。MV 发作时较高的气道压力、较高的 PEEP 和较高的 BMI 与 MV 发作后发生 ARDS 相关。