Management of Severe Acute Respiratory Distress Syndrome in Australia and New Zealand (SAGE-ANZ): An Observational Study

Overview

Journal Crit Care Resusc

Specialties Anesthesiology
Critical Care

Date 2024 Oct 2

PMID 39355498

Authors

Rachael L Parke

Shay P McGuinness

Alana Cavadino

Keri-Anne Cowdrey

Samantha Bates

Shailesh Bihari

Amanda Corley

Eileen Gilder

Carol Hodgson

Edward Litton

Colin McArthur

Alistair Nichol

Jane Parker

Anne Turner

Steve Webb

Frank Mp van Haren

Affiliations

Soon will be listed here.

Abstract

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) PaO/FiO ratio 119 (89, 142), median (IQR) FiO 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmHO. 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 HO). 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.

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