The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era
OBJECTIVES:. To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN:. A 6-month pr...
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-05-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000684 |
| _version_ | 1811236981541175296 |
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| author | Jesús Villar, MD, PhD, FCCM Juan M. Mora-Ordoñez, MD Juan A. Soler, MD, PhD Fernando Mosteiro, MD, PhD Anxela Vidal, MD Alfonso Ambrós, MD, PhD Lorena Fernández, MD Isabel Murcia, MD Belén Civantos, MD Miguel A. Romera, MD Adrián Mira, MD Francisco J. Díaz-Domínguez, MD Dácil Parrilla, MD J. Francisco Martínez-Carmona, MD Domingo Martínez, MD Lidia Pita-García, MD Denis Robaglia, MD Ana Bueno-González, MD Jesús Sánchez-Ballesteros, MD Ángel E. Pereyra, MD Mónica Hernández, MD Carlos Chamorro-Jambrina, MD Pilar Cobeta, MD Raúl I. González-Luengo, MD Raquel Montiel, MD Leonor Nogales, MD M. Mar Fernández, MD, PhD Blanca Arocas, MD Álvaro Valverde-Montoro, MD Ana M. del Saz-Ortiz, MD Victoria Olea-Jiménez, MD José M. Añón, MD, PhD Pedro Rodríguez-Suárez, MD Rosa L. Fernández, MSc Cristina Fernández, MSc Tamas Szakmany, MD, PhD Jesús M. González-Martín, PhD Carlos Ferrando, MD, PhD Robert M. Kacmarek, PhD, RTT Arthur S. Slutsky, MD for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) Network José M. Añón Belén Civantos Mónica Hernández Elena González Rosario Solano F. Javier Díaz-Domínguez Demetrio Carriedo Raul I. González Luengo Carlos Ferrando Blanca Arocas Javier Belda Marina Soro Gerardo Aguilar Ernesto Pastor Lorena Fernández Jesús Sánchez-Ballesteros Arturo Muriel Pablo Blanco-Schweizer José Ángel de Ayala Jesús Blanco César Aldecoa Alba Pérez Jesús Rico-Feijoo Leonor Nogales David Andaluz Laura Parra Juan A. Soler Domingo Martínez Ana M. del Saz-Ortiz Alfonso Ambrós Ana Bueno-González Carmen Hornos-López Raquel Montiel Dácil Parrilla Eduardo Peinado Isidro Prieto Mario Chico Miguel A. Romera Carlos Chamorro-Jambrina Juan M. Mora-Ordoñez J. Francisco Martínez-Carmona Álvaro Valverde-Montoro Victoria Olea-Jiménez Paco Alba Ruth Corpas Fernando Mosteiro Lidia Pita-García Eleuterio Merayo Chanel Martínez Ángeles de Célis-Álvarez Carmen Martín-Delgado Adrián Mira Pilar Cobeta David Pestaña María del Mar Fernández Concepción Tarancón Silvia Cortés-Díaz Anxela Vidal Denis Robaglia César Pérez Isabel Murcia Ángel E. Pereyra-Pache Tamas Szakmany Jesús Villar Rosa L. Fernández Cristina Fernández Pedro Rodríguez-Pérez Jesús M. González-Martín Robert M. Kacmarek Arthur S. Slutsky |
| author_facet | Jesús Villar, MD, PhD, FCCM Juan M. Mora-Ordoñez, MD Juan A. Soler, MD, PhD Fernando Mosteiro, MD, PhD Anxela Vidal, MD Alfonso Ambrós, MD, PhD Lorena Fernández, MD Isabel Murcia, MD Belén Civantos, MD Miguel A. Romera, MD Adrián Mira, MD Francisco J. Díaz-Domínguez, MD Dácil Parrilla, MD J. Francisco Martínez-Carmona, MD Domingo Martínez, MD Lidia Pita-García, MD Denis Robaglia, MD Ana Bueno-González, MD Jesús Sánchez-Ballesteros, MD Ángel E. Pereyra, MD Mónica Hernández, MD Carlos Chamorro-Jambrina, MD Pilar Cobeta, MD Raúl I. González-Luengo, MD Raquel Montiel, MD Leonor Nogales, MD M. Mar Fernández, MD, PhD Blanca Arocas, MD Álvaro Valverde-Montoro, MD Ana M. del Saz-Ortiz, MD Victoria Olea-Jiménez, MD José M. Añón, MD, PhD Pedro Rodríguez-Suárez, MD Rosa L. Fernández, MSc Cristina Fernández, MSc Tamas Szakmany, MD, PhD Jesús M. González-Martín, PhD Carlos Ferrando, MD, PhD Robert M. Kacmarek, PhD, RTT Arthur S. Slutsky, MD for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) Network José M. Añón Belén Civantos Mónica Hernández Elena González Rosario Solano F. Javier Díaz-Domínguez Demetrio Carriedo Raul I. González Luengo Carlos Ferrando Blanca Arocas Javier Belda Marina Soro Gerardo Aguilar Ernesto Pastor Lorena Fernández Jesús Sánchez-Ballesteros Arturo Muriel Pablo Blanco-Schweizer José Ángel de Ayala Jesús Blanco César Aldecoa Alba Pérez Jesús Rico-Feijoo Leonor Nogales David Andaluz Laura Parra Juan A. Soler Domingo Martínez Ana M. del Saz-Ortiz Alfonso Ambrós Ana Bueno-González Carmen Hornos-López Raquel Montiel Dácil Parrilla Eduardo Peinado Isidro Prieto Mario Chico Miguel A. Romera Carlos Chamorro-Jambrina Juan M. Mora-Ordoñez J. Francisco Martínez-Carmona Álvaro Valverde-Montoro Victoria Olea-Jiménez Paco Alba Ruth Corpas Fernando Mosteiro Lidia Pita-García Eleuterio Merayo Chanel Martínez Ángeles de Célis-Álvarez Carmen Martín-Delgado Adrián Mira Pilar Cobeta David Pestaña María del Mar Fernández Concepción Tarancón Silvia Cortés-Díaz Anxela Vidal Denis Robaglia César Pérez Isabel Murcia Ángel E. Pereyra-Pache Tamas Szakmany Jesús Villar Rosa L. Fernández Cristina Fernández Pedro Rodríguez-Pérez Jesús M. González-Martín Robert M. Kacmarek Arthur S. Slutsky |
| author_sort | Jesús Villar, MD, PhD, FCCM |
| collection | DOAJ |
| description | OBJECTIVES:. To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV).
DESIGN:. A 6-month prospective, epidemiological, observational study.
SETTING:. A network of 22 multidisciplinary ICUs in Spain.
PATIENTS:. Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837).
CONCLUSIONS:. AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies. |
| first_indexed | 2024-04-12T12:18:05Z |
| format | Article |
| id | doaj.art-b683f9f5f7364cd08c59c3940ccadbd0 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-12T12:18:05Z |
| publishDate | 2022-05-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-b683f9f5f7364cd08c59c3940ccadbd02022-12-22T03:33:23ZengWolters KluwerCritical Care Explorations2639-80282022-05-0145e068410.1097/CCE.0000000000000684202205000-00004The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 EraJesús Villar, MD, PhD, FCCM0Juan M. Mora-Ordoñez, MD1Juan A. Soler, MD, PhD2Fernando Mosteiro, MD, PhD3Anxela Vidal, MD4Alfonso Ambrós, MD, PhD5Lorena Fernández, MD6Isabel Murcia, MD7Belén Civantos, MD8Miguel A. Romera, MD9Adrián Mira, MD10Francisco J. Díaz-Domínguez, MD11Dácil Parrilla, MD12J. Francisco Martínez-Carmona, MD13Domingo Martínez, MD14Lidia Pita-García, MD15Denis Robaglia, MD16Ana Bueno-González, MD17Jesús Sánchez-Ballesteros, MD18Ángel E. Pereyra, MD19Mónica Hernández, MD20Carlos Chamorro-Jambrina, MD21Pilar Cobeta, MD22Raúl I. González-Luengo, MD23Raquel Montiel, MD24Leonor Nogales, MD25M. Mar Fernández, MD, PhD26Blanca Arocas, MD27Álvaro Valverde-Montoro, MD28Ana M. del Saz-Ortiz, MD29Victoria Olea-Jiménez, MD30José M. Añón, MD, PhD31Pedro Rodríguez-Suárez, MD32Rosa L. Fernández, MSc33Cristina Fernández, MSc34Tamas Szakmany, MD, PhD35Jesús M. González-Martín, PhD36Carlos Ferrando, MD, PhD37Robert M. Kacmarek, PhD, RTT38Arthur S. Slutsky, MD39for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) NetworkJosé M. AñónBelén CivantosMónica HernándezElena GonzálezRosario SolanoF. Javier Díaz-DomínguezDemetrio CarriedoRaul I. González LuengoCarlos FerrandoBlanca ArocasJavier BeldaMarina SoroGerardo AguilarErnesto PastorLorena FernándezJesús Sánchez-BallesterosArturo MurielPablo Blanco-SchweizerJosé Ángel de AyalaJesús BlancoCésar AldecoaAlba PérezJesús Rico-FeijooLeonor NogalesDavid AndaluzLaura ParraJuan A. SolerDomingo MartínezAna M. del Saz-OrtizAlfonso AmbrósAna Bueno-GonzálezCarmen Hornos-LópezRaquel MontielDácil ParrillaEduardo PeinadoIsidro PrietoMario ChicoMiguel A. RomeraCarlos Chamorro-JambrinaJuan M. Mora-OrdoñezJ. Francisco Martínez-CarmonaÁlvaro Valverde-MontoroVictoria Olea-JiménezPaco AlbaRuth CorpasFernando MosteiroLidia Pita-GarcíaEleuterio MerayoChanel MartínezÁngeles de Célis-ÁlvarezCarmen Martín-DelgadoAdrián MiraPilar CobetaDavid PestañaMaría del Mar FernándezConcepción TarancónSilvia Cortés-DíazAnxela VidalDenis RobagliaCésar PérezIsabel MurciaÁngel E. Pereyra-PacheTamas SzakmanyJesús VillarRosa L. FernándezCristina FernándezPedro Rodríguez-PérezJesús M. González-MartínRobert M. KacmarekArthur S. Slutsky1 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.4 Intensive Care Unit, Hospital Universitario Regional Carlos Haya, Málaga, Spain.5 Intensive Care Unit, Hospital Universitario Virgen de Arrixaca, Murcia, Spain.6 Intensive Care Unit, Hospital Universitario de A Coruña, La Coruña, Spain.7 Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.8 Intensive Care Unit, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.9 Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain.10 Intensive Care Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.11 Intensive Care Unit, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.12 Intensive Care Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.13 Department of Anesthesia, Hospital Universitario Ramón y Cajal, Madrid, Spain.14 Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain.15 Intensive Care Unit, Hospital Universitario N.S. de Candelaria, Santa Cruz de Tenerife, Spain.4 Intensive Care Unit, Hospital Universitario Regional Carlos Haya, Málaga, Spain.5 Intensive Care Unit, Hospital Universitario Virgen de Arrixaca, Murcia, Spain.6 Intensive Care Unit, Hospital Universitario de A Coruña, La Coruña, Spain.7 Intensive Care Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.8 Intensive Care Unit, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.9 Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain.10 Intensive Care Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.11 Intensive Care Unit, Hospital Universitario La Paz, IdiPaz, Madrid, Spain.12 Intensive Care Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.13 Department of Anesthesia, Hospital Universitario Ramón y Cajal, Madrid, Spain.14 Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain.15 Intensive Care Unit, Hospital Universitario N.S. de Candelaria, Santa Cruz de Tenerife, Spain.16 Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.17 Intensive Care Unit, Hospital Universitario Mutua Terrassa, Terrassa, Barcelona, Spain.18 Surgical Intensive Care Unit, Department of Anesthesia, Hospital Clínico de Valencia, Valencia, Spain.4 Intensive Care Unit, Hospital Universitario Regional Carlos Haya, Málaga, Spain.5 Intensive Care Unit, Hospital Universitario Virgen de Arrixaca, Murcia, Spain.4 Intensive Care Unit, Hospital Universitario Regional Carlos Haya, Málaga, Spain.1 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.19 Department of Thoracic Surgery, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.1 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.2 Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.20 Intensive Care Medicine & Anaesthesia, Aneurin Bevan UHB, Newport, United Kingdom.2 Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain.1 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.23 Department of Respiratory Care, Massachusetts General Hospital, Boston, MA.3 Li Ka Shing Knowledge Institute at St. Michael’s Hospital, Toronto, ON, Canada.OBJECTIVES:. To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN:. A 6-month prospective, epidemiological, observational study. SETTING:. A network of 22 multidisciplinary ICUs in Spain. PATIENTS:. Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837). CONCLUSIONS:. AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.http://journals.lww.com/10.1097/CCE.0000000000000684 |
| spellingShingle | Jesús Villar, MD, PhD, FCCM Juan M. Mora-Ordoñez, MD Juan A. Soler, MD, PhD Fernando Mosteiro, MD, PhD Anxela Vidal, MD Alfonso Ambrós, MD, PhD Lorena Fernández, MD Isabel Murcia, MD Belén Civantos, MD Miguel A. Romera, MD Adrián Mira, MD Francisco J. Díaz-Domínguez, MD Dácil Parrilla, MD J. Francisco Martínez-Carmona, MD Domingo Martínez, MD Lidia Pita-García, MD Denis Robaglia, MD Ana Bueno-González, MD Jesús Sánchez-Ballesteros, MD Ángel E. Pereyra, MD Mónica Hernández, MD Carlos Chamorro-Jambrina, MD Pilar Cobeta, MD Raúl I. González-Luengo, MD Raquel Montiel, MD Leonor Nogales, MD M. Mar Fernández, MD, PhD Blanca Arocas, MD Álvaro Valverde-Montoro, MD Ana M. del Saz-Ortiz, MD Victoria Olea-Jiménez, MD José M. Añón, MD, PhD Pedro Rodríguez-Suárez, MD Rosa L. Fernández, MSc Cristina Fernández, MSc Tamas Szakmany, MD, PhD Jesús M. González-Martín, PhD Carlos Ferrando, MD, PhD Robert M. Kacmarek, PhD, RTT Arthur S. Slutsky, MD for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) Network José M. Añón Belén Civantos Mónica Hernández Elena González Rosario Solano F. Javier Díaz-Domínguez Demetrio Carriedo Raul I. González Luengo Carlos Ferrando Blanca Arocas Javier Belda Marina Soro Gerardo Aguilar Ernesto Pastor Lorena Fernández Jesús Sánchez-Ballesteros Arturo Muriel Pablo Blanco-Schweizer José Ángel de Ayala Jesús Blanco César Aldecoa Alba Pérez Jesús Rico-Feijoo Leonor Nogales David Andaluz Laura Parra Juan A. Soler Domingo Martínez Ana M. del Saz-Ortiz Alfonso Ambrós Ana Bueno-González Carmen Hornos-López Raquel Montiel Dácil Parrilla Eduardo Peinado Isidro Prieto Mario Chico Miguel A. Romera Carlos Chamorro-Jambrina Juan M. Mora-Ordoñez J. Francisco Martínez-Carmona Álvaro Valverde-Montoro Victoria Olea-Jiménez Paco Alba Ruth Corpas Fernando Mosteiro Lidia Pita-García Eleuterio Merayo Chanel Martínez Ángeles de Célis-Álvarez Carmen Martín-Delgado Adrián Mira Pilar Cobeta David Pestaña María del Mar Fernández Concepción Tarancón Silvia Cortés-Díaz Anxela Vidal Denis Robaglia César Pérez Isabel Murcia Ángel E. Pereyra-Pache Tamas Szakmany Jesús Villar Rosa L. Fernández Cristina Fernández Pedro Rodríguez-Pérez Jesús M. González-Martín Robert M. Kacmarek Arthur S. Slutsky The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era Critical Care Explorations |
| title | The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era |
| title_full | The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era |
| title_fullStr | The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era |
| title_full_unstemmed | The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era |
| title_short | The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era |
| title_sort | pandora study prevalence and outcome of acute hypoxemic respiratory failure in the pre covid 19 era |
| url | http://journals.lww.com/10.1097/CCE.0000000000000684 |
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pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT concepciontarancon pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT silviacortesdiaz pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT anxelavidal pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT denisrobaglia pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT cesarperez pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT isabelmurcia pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT angelepereyrapache pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT tamasszakmany pandorastudyprevalenceandoutcomeofacutehypoxemicrespiratoryfailureintheprecovid19era AT jesusvillar 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