目的:急性低氧性呼吸衰竭(AHRF)是重症监护病房(ICU)入院的常见原因。然而,患者特征,结果,和趋势随着时间的推移是不清楚的。我们描述了AHRF患者随时间的流行病学和结果。
方法:在此二进制中,在2005年至2022年的基于注册表的研究中,我们纳入了所有入住澳大利亚或新西兰ICU且在ICU入住的前24小时内出现动脉血气的成年人.AHRF定义为氧气/吸入氧气的分压比(PaO2/FiO2)≤300。主要结局是调整后的住院死亡率,根据PaO2/FiO2分类(轻度:200-300,中度:100-200,重度<100,且非线性)。我们调查了调整后的死亡率是如何根据时间趋势(按入院年份)演变的,性别,年龄,入院诊断和接受机械通气。
结果:在1,560,221名患者中,在ICU住院的前24小时内,有826,106人(52.9%)入院或发展为AHRF。在这826,106名患者中,51.4%有轻度,39.3%有中度,9.3%有严重的AHRF。与没有AHRF的患者相比(5.3%),轻度患者(8%),中度(14.2%)和重度(29.9%)AHRF的院内死亡率较高.随着PaO2/FiO2比值的降低,调整后的住院死亡率逐渐增加,特别是在PaO2/FiO2比率为200的拐点以下。所有患者调整后的住院死亡率随着时间的推移而下降(2005年为13.3%,2022年为8.2%)。这种趋势在有和没有AHRF的患者中相似。
结论:AHRF导致的医疗保健负担可能比预期的要大,严重AHRF的死亡率仍然很高。尽管死亡率随着时间的推移而下降,这可能反映了ICU护理的总体改善,而不是专门在AHRF中。需要更多的研究来更早地识别AHRF,并对这些患者早期恶化的风险进行分层。并验证我们的发现。
OBJECTIVE: Acute hypoxaemic respiratory failure (AHRF) is a common reason for intensive care unit (ICU) admission. However, patient characteristics, outcomes, and trends over time are unclear. We describe the epidemiology and outcomes of patients with AHRF over time.
METHODS: In this binational, registry-based study from 2005 to 2022, we included all adults admitted to an Australian or New Zealand ICU with an arterial blood gas within the first 24 h of ICU stay. AHRF was defined as a partial pressure of oxygen/inspired oxygen ratio (PaO2/FiO2) ≤ 300. The primary outcome was adjusted in-hospital mortality, categorised based on PaO2/FiO2 (mild: 200-300, moderate: 100-200, and severe < 100, and non-linearly). We investigated how adjusted mortality evolved based on temporal trends (by year of admission), sex, age, admission diagnosis and the receipt of mechanical ventilation.
RESULTS: Of 1,560,221 patients, 826,106 (52.9%) were admitted with or developed AHRF within the first 24 h of ICU stay. Of these 826,106 patients, 51.4% had mild, 39.3% had moderate, and 9.3% had severe AHRF. Compared to patients without AHRF (5.3%), patients with mild (8%), moderate (14.2%) and severe (29.9%) AHRF had higher in-hospital mortality rates. As PaO2/FiO2 ratio decreased, adjusted in-hospital mortality progressively increased, particularly below an inflection point at a PaO2/FiO2 ratio of 200. The adjusted in-hospital mortality for all patients decreased over time (13.3% in 2005 to 8.2% in 2022), and this trend was similar in patients with and without AHRF.
CONCLUSIONS: The healthcare burden due to AHRF may be larger than expected, and mortality rates remain high in severe AHRF. Although mortality has decreased over time, this may reflect improvements in ICU care in general, rather than specifically in AHRF. More research is required to earlier identify AHRF and stratify these patients at risk of deterioration early, and to validate our findings.