National survey of outcomes and practices in acute respiratory distress syndrome in Singapore

Abstract

IntroductionIn the past 20 years, our understanding of acute respiratory distress syndrome (ARDS) management has improved, but the worldwide incidence and current outcomes are unclear. The reported incidence is highly variable, and no studies specifically characterise ARDS epidemiology in Asia. This observation study aims to determine the incidence, mortality and management practices of ARDS in a high income South East Asian country.MethodsWe conducted a prospective, population based observational study in 6 public hospitals. During a one month period, we identified all ARDS patients admitted to public hospital intensive care units (ICU) in Singapore, according to the Berlin definition. Demographic information, clinical management data and ICU outcome data was collected.ResultsA total of 904 adult patients were admitted to ICU during the study period and 15 patients met ARDS criteria. The unadjusted incidence of ARDS was 4.5 cases per 100,000 population, accounting for 1.25% of all ICU patients. Most patients were male (75%), Chinese (62%), had pneumonia (73%), and were admitted to a Medical ICU (56%). Management strategies varied across all ICUs. In-hospital mortality was 40% and median length of ICU stay was 7 days.ConclusionThe incidence of ARDS in a developed S.E Asia country is comparable to reported rates in European studies.

Validation of age, PaO2/FlO2 and plateau pressure score in Korean patients with acute respiratory distress syndrome: a retrospective cohort study

“…It has not been validated in an Asian population. Few studies have examined the geographic variation in the incidence rate of ARDS as defined by the Berlin criteria, and it remains unclear whether the features of ARDS in Asia differ from those in Western countries [4,11]. In this context, we aimed to validate APPS externally for mechanically ventilated ARDS patients in Korea and assess the differences between Asian and Western populations.…”

Intermediate tidal volume is an acceptable option for ventilated patients with acute respiratory distress syndrome

“…Intermediate V T was found in some studies to be the most commonly applied ventilator setting for patients with ARDS. 14 , 15 …”

National incidence rate and related mortality for acute respiratory distress syndrome in France

“…The 2012 update of the ARDS definition (Berlin definition) stratified the severity of ARDS according to the PaO 2 /FiO 2 ratio (mild 200–300 mmHg, moderate 100–200 mmHg, severe < 100 mmHg) [4] . Only a few large epidemiological studies have been conducted since the publication of this new definition [5] , [6] , [7] . The LUNG SAFE (Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE) international survey involved patients admitted during winter 2014 to one of the 459 voluntary ICUs from 50 countries within the 4-week enrolment window who were receiving invasive or non-invasive ventilation [8] .…”