The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era
Jesús Villar, Juan M. Mora-Ordoñez, Juan A. Soler, Fernando Mosteiro, Anxela Vidal, Alfonso Ambrós, Lorena Fernández, Isabel Murcia, Belén Civantos, Miguel A. Romera, Adrián Mira, Francisco J. Díaz-Domínguez, Dácil Parrilla, J. Francisco Martínez-Carmona, Domingo Martínez, Lidia Pita-García, Denis Robaglia, Ana Bueno-González, Jesús Sánchez-Ballesteros, Ángel E. Pereyra, Mónica Hernández, Carlos Chamorro-Jambrina, Pilar Cobeta, Raúl I. González-Luengo, Raquel Montiel, Leonor Nogales, M. Mar Fernández, Blanca Arocas, Álvaro Valverde-Montoro, Ana M. del Saz-Ortiz, Victoria Olea-Jiménez, José M. Añón, Pedro Rodríguez-Suárez, Rosa L. Fernández, Cristina Fernández, Tamas Szakmany, Jesús M. González-Martín, Carlos Ferrando, Robert M. Kacmarek, Arthur S. Slutsky, for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) Network
Abstract
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 Pa o 2 /F io 2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H 2 O and F io 2 ≥ 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 H 2 O, F io 2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H 2 O. ARDS patients received higher F io 2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H 2 O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H 2 O, 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.