title: Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study.
abstract: Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS.
  
  
  
  PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed.
  
  
  
  Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27-33), representing 0·14 cases per ICU bed over a 1-week period. VTwas similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7-9·1] vs 7·9 mL/kg PBW [6·8-9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0-8·0] vs 5·0 cm H2O [5·0-7·0]; p<0·0001). The prevalence of ARDS in patients at risk of ARDS was higher than in individuals not at risk of ARDS (19/260 [7%] vs 17/556 [3%]; p=0·004). Compared with individuals not at risk of ARDS, patients at risk of ARDS had higher in-hospital mortality (86/543 [16%] vs 74/232 [32%]; p<0·0001), ICU mortality (62/533 [12%] vs 66/227 [29%]; p<0·0001), and 90-day mortality (109/653 [17%] vs 88/282 [31%]; p<0·0001). VTdid not differ between patients who did and did not develop ARDS (p=0·471 for those at risk of ARDS; p=0·323 for those not at risk).
  
  
  
  Around a third of patients receiving mechanical ventilation in the ICU were at risk of ARDS. Pulmonary complications occur frequently in patients at risk of ARDS and their clinical outcome is worse compared with those not at risk of ARDS. There is potential for improvement in the management of patients without ARDS. Further refinements are needed for prediction of ARDS.
  
  
  
  None.
authors.affiliation: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, Netherlands; Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: aryserpa@terra.com.br.
authors.forename: Ary Serpa
authors.initials: AS
authors.lastname: Neto
authors.affiliation: Department of Intensive Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil; Department of Pulmonology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Carmen S V
authors.initials: CSV
authors.lastname: Barbas
authors.affiliation: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Fabienne D
authors.initials: FD
authors.lastname: Simonis
authors.affiliation: Department of Intensive Care Medicine, Hospital de Sabadell, CIBER de Enfermedades Respiratorias, Corporació Sanitaria I Universitària Parc Taulí, Sabadell, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas-Raventós
authors.affiliation: Department of Anesthesiology, Hospital Universitari Germans Trias I Pujol, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Canet
authors.affiliation: Department of Critical Care, Westfriesgasthuis, Hoorn, Netherlands.
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.affiliation: Department of Intensive Care, St Vincent's Hospital, Melbourne, VIC, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Anstey
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Goran
authors.initials: G
authors.lastname: Hedenstierna
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Sabrine N T
authors.initials: SNT
authors.lastname: Hemmes
authors.affiliation: Medical Intensive Care Unit, Division of General Internal Medicine, University Hospital Leuven, Leuven, Belgium; Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
authors.forename: Greet
authors.initials: G
authors.lastname: Hermans
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.affiliation: Department of Critical Care Medicine and Anesthesiology (SAR B), Saint Eloi University Hospital, Montpellier, France.
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.affiliation: Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: Department of Anaesthesia and Critical Care Medicine, Sheffield Teaching Hospital, Sheffield, UK.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Mills
authors.affiliation: Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Rupert M
authors.initials: RM
authors.lastname: Pearse
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Putensen
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Schmid
authors.affiliation: Department of Biotechnologies and Sciences of Life, Insubria University, Varese, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Severgnini
authors.affiliation: Department of Intensive Care, St Vincent's Hospital, Melbourne, VIC, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Smith
authors.affiliation: Department of Anaesthesiology, Düsseldorf University Hospital, Düsseldorf, Germany.
authors.forename: Tanja A
authors.initials: TA
authors.lastname: Treschan
authors.affiliation: Division of Cardiac, Thoracic, and Vascular Anesthesia and Intensive Care, Medical University Vienna, Vienna, Austria.
authors.forename: Edda M
authors.initials: EM
authors.lastname: Tschernko
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Marcos F V
authors.initials: MFV
authors.lastname: Melo
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Wrigge
authors.affiliation: Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, and Technische Universität Dresden, Dresden, Germany.
authors.forename: Marcelo Gama
authors.initials: MG
authors.lastname: de Abreu
authors.affiliation: Department of Surgical Sciences and Integrated Diagnostics, IRCCS San Martino IST, University of Genoa, Genoa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.affiliation: Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000009:adverse effects* / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013990:Tidal Volume