A cross-sectional survey of mechanical ventilation in ICU patients with ARDS in multiple provinces in China
Objective To improve the practice and management quality of mechanical ventilation-related treatments for ICU patients by evaluating the differences in mechanical ventilation-related treatments among ICU patients in multiple provinces in China.Methods On September 29,2022,a cross-sectional survey of mechanical ventilation in patients with acute respiratory distress syndrome(ARDS)was conducted through questionnaires.Results ARDS accounted for 11.7％of the total cases,mainly male patients.In the etiologies of ARDS,primary pneumonia was the main intrapulmonary factor,while extrapulmonary factors mainly involved the digestive system(such as intestinal perforation and obstruction)and neurological diseases(such as stroke).Among the collected cases,non-aspiration pneumonia was the main source of ARDS(79.17％),followed by pulmonary infections(76.92％),and intestinal infection was also a more common source.In the diagnosis of ARDS,the Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ)indicated that the proportions of critically ill and moderate to severe patients were 75.00％and 47.92％,respectively.The application of lung ultrasound in severe ARDS patients was relatively common,accounting for 56.25％of the admitted cases,while the practice rate of diaphragmatic ultrasound was low,only 18.75％,and all occurred in Grade Ⅲ Level A hospitals.The overall implementation rate of subglottic secretion suction was 45.71％,and there was no significant difference between the intrapulmonary and extrapulmonary groups in the implementation groups.The implementation rate of airbag pressure monitoring was 62.86％,with the highest implementation rate in Grade Ⅲ Level A hospitals in the eastern region.In terms of ARDS treatment,the ventilation mode was mainly pressure-controlled ventilation(62.86％),with humidified high-flow oxygen therapy accounting for 76.92％and ordinary humidified oxygen therapy accounting for 23.08％.The implementation rate of low tidal volume ventilation was 68.57％,with higher implementation rates in Grade Ⅲ Level A hospitals(the intrapulmonary group)in the eastern region and Grade Ⅲ Level A hospitals(the extrapulmonary group)in the central region.The implementation rates of treatment for high respiratory rate,high positive end-expiratory pressure(PEEP),and hypercapnia were relatively low,which may he related to the course and underlying disease of the disease.The implementation rate of sedation and analgesia was 62.86％.Conclusion The diagnosis and treatment of ARDS require comprehensive consideration of the patient's condition and clinical manifestations.In treatment,the implementation rates of ventilation mode,humidified oxygen therapy,low tidal volume,etc.were relatively high,but the implementation rates of treatment for high respiratory rate,PEEP,and hypercapnia were low and needed to be strengthened.In addition,the prevention and early intervention of ARDS should he strengthened to reduce its incidence and mortality rate.
Intensive Care UnitInvasive ventilator-assisted ventilationAcute respiratory distress syndromeBedside ultrasound in critically ill patientsCross-sectional survey
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