IMPORTANCE Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS). OBJECTIVES To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts-for example prone positioning-in routine clinical practice for patients fulfilling the ARDS Berlin Definition. DESIGN, SETTING, AND PARTICIPANTS The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents. EXPOSURES Acute respiratory distress syndrome. MAIN OUTCOMES AND MEASURES The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS. RESULTS Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H 2 O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS. CONCLUSIONS AND RELEVANCE Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Background Our study aimed to investigate the prognostic value of a novel in ammatory index, systemic immune-in ammation index (SII), with the clinical outcomes of patients infected with coronavirus disease 2019 (COVID-19). Methods We evaluated a cohort study of COVID-19 patients (18-95 years old) in Tongji Hospital of Huazhong University of Science and Technology from January 28th 2020 to February 29th 2020. The enrolled patients were divided into two groups (including low-SII group and high-SII group) according to the cutoff point which is analyzed by receiver operating characteristic (ROC) curve. Univariate and multivariate COX regression analysis were performed to identify the factors associated with the outcomes of patients with COVID-19 infection. The primary and secondary outcome were in-hospital mortality and the development of acute respiratory distress syndrome (ARDS), respectively. Results A number of 326 adult patients (43.87% males, 61.22 ± 0.86 years) were enrolled in the nal analyses. There were 147 cases (45.09%) died in hospital and 116 patients (35.58%) developed ARDS. ROC curve analysis indicated that the SII had a greater prediction accuracy in predicting the in-hospital mortality (area under the curve [AUC] = 0.789, sensitivity = 69.90%, speci city = 70.80%) and the development of ARDS (AUC = 0.736, sensitivity = 67.80%, speci city = 71.10%). Kaplan-Meier analysis revealed that patients in high-SII group had a greater risk of adverse clinical outcomes (all P < 0.001). The multivariate Cox regression analysis indicated that elevated SII was found as the risk predictor of inhospital mortality (hazard ratio [HR] = 2.839, 95% con dence interval [CI] = 1.116-7.222, P = 0.028) and the developed ARDS (HR = 6.832, 95%CI = 2.583-18.074, P < 0.001). Additional signi cant independent predictor for adverse outcomes was the lymphocyte proportion. What's more, it suggests that the invasive mechanical ventilation performed in the early stage of the disease progression may be bene cial for patients. Conclusion SII, a novel biomarker, might be a remarkable prognostic indicator to assess the in-hospital mortality and the development of ARDS in patients with COVID-19 and help for clinical risk assessment. however, it is much more infectious [5]. The primary way that SARS-CoV-2 appears to spread is mainly by close person-to-person contact via droplets [6]. The clinical features of COVID-19 covered from asymptomatic or mild symptoms, to severe cases with acute respiratory distress syndrome (ARDS) or organ failure [7]. The underlying mechanism of the disease is still unclear. Preliminary studies showed that system in ammatory response played an important role in the progression of the disease [8, 9]. According to Matthew Zirui Tay et al research, for the immune system damage and the uncontrolled in ammatory response brought to human, COVID-19 could cause damage and functional impairment of major organs [10]. Therefore, it is essential to nd sensitive biomarkers, which associate with the in ammatory status and are ...

ClinicalTrials.gov NCT02010073.