gms | German Medical Science

Background: The acute respiratory distress syndrome (ARDS) is a severe, life-threatening condition. It requires intensive medical care and is associated with high in-hospital mortality and severe long-term sequelae in survivors. Despite evidence on efficacious treatment strategies for ARDS patients generated in high quality randomized controlled studies, little is known about the characteristics of ARDS patients and the care provided to them in real world health care. However, understanding these is a prerequisite if evidence-based therapy is to be translated into routine healthcare.

Research Question: What are the socio-demographic and clinical characteristics of patients with ARDS and which care is provided to them in intensive care units (ICUs) in Germany?

Methods: Data for descriptive analyses presented was collected at 59 ICUs in hospitals of different levels of care in the context of a large Germany-wide prospective cohort study (DACAPO). Informed consent provided by patients themselves or their legal guardians was available for 700 patients. Socio-demographic, clinical and care-related variables were assessed during ICU stay and gathered through electronic case report forms. Descriptive statistics were computed.

Results: Of 700 enrolled patients, about two thirds were male and half were 58 years old or older (IQR (interquartile range): 46-69). 16% had a high educational level (> 10 years of schooling), 12% had no professional qualification and 60% were currently without employment, predominantly due to retirement.

One-third of patients had been transferred from another hospital before enrollment in one of the participating ICUs. The main cause of ARDS was a pulmonary ‘direct’ origin (79%). The degree of severity of ARDS was unequally distributed, with 48 % of the ARDS cases classified as moderate and 38% as severe. The most frequent comorbidities comprised cancer and alcohol disorder.

Among different supportive measures, tracheotomy was applied in about half (53%) of the patients, followed by prone positioning (45%) and extracorporeal membrane oxygenation (31%). Both muscle-relaxant medication and NO-inhalation were used only in about 10% of patients. The occurrence of procedural critical events (hypoxemia, hypoglycemia, re-intubation) was relatively high (47%). One third of patients died during the ICU stay. The median length of the ICU stay until death/discharge was 21 days (IQR: 13-34).

Discussion: The detailed description of the educational level and employment situation of patients with ARDS is an important novel aspect of this study. The main characteristics of this cohort correspond to previously investigated populations of patients with ARDS regarding sex, age and mortality. However, a remarkable deviation from the expected distribution of the severity of ARDS was found. It should be noted that in contrast to many other studies no exclusion criteria such as cause or severity of disease, comorbidity or age were applied.

Practical Implications: The remarkably high occurrence of critical events and the large heterogeneity in the use of supportive measures for ARDS in ICU care provide important insights into the current state of health care for ARDS in Germany.