Critical Care Explorations (May 2022)

The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era

  • 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

DOI
https://doi.org/10.1097/CCE.0000000000000684
Journal volume & issue
Vol. 4, no. 5
p. e0684

Abstract

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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.