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

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.引言 过去20年间，学界对急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）的诊疗认知已显著提升，但全球范围内其发病率与当前预后仍不明确。现有报道的发病率差异悬殊，目前尚无专门针对亚洲地区ARDS流行病学特征的研究。本观察性研究旨在明确某高收入东南亚国家中ARDS的发病率、病死率及临床诊疗实践现状。 方法 本研究于新加坡6家公立医院开展一项基于人群的前瞻性观察研究。在为期1个月的研究周期内，依据柏林定义，筛选出新加坡公立医院重症监护病房（intensive care unit, ICU）收治的全部ARDS患者，收集患者的人口统计学资料、临床诊疗数据及ICU预后相关数据。 结果 研究周期内共有904名成年患者入住ICU，其中15名符合ARDS诊断标准。未经校正的ARDS发病率为每10万人口4.5例，占同期所有ICU收治患者的1.25%。多数患者为男性（75%）、华裔（62%），因肺炎入院（73%），且入住内科ICU（56%）。各ICU间的诊疗策略存在明显差异。住院病死率为40%，ICU中位停留时长为7天。 结论 该发达东南亚国家的ARDS发病率与欧洲现有研究报道的水平基本相当。