Why and how do we need comprehensive international clinical epidemiology of ARDS?

 

Why and how do we need comprehensive international clinical epidemiology of ARDS?

By: Gianni Tognoni, Luigi Vivona & Antonio Pesenti 

Intensive Care Medicine Published: 03 July 2021

One of the most evident weaknesses of scientific and public health strategies in the management of the coronavirus disease 2019 (COVID-19) pandemic is certainly the scarcity of robust epidemiological data, not limited to the quali-quantitative descriptions of patient populations and their outcomes, specifically in the hardly comparable ICU settings of care, but aimed at what has become the core and the vocation of a clinically oriented epidemiological investigation. Clinical data collected and analysed with sound methodological criteria are the essential source of information, closely complementary to physio-pathological data for a better understanding of the causes of the outcomes of critical and still uncertain clinical conditions.

The substantial absence of this type of epidemiology has suggested a broader question: whether and how far the failure documented in publications relating to the ICU phases of Covid-19 coincides with the state of the art also for the acute respiratory distress syndrome (ARDS), closely overlapping the severe pulmonary involvement seen in a small but dramatic fraction of the Covid-19-infected population.

We felt that a targeted survey of the clinical epidemiological literature could provide an overview of the methodological strengths and weaknesses of recent research, and serve as an informed suggestion as to most practicable strategies…

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

Epidemiology and prognosis of anti-infective therapy in the ICU setting during acute pancreatitis: a cohort study

by Philippe Montravers, Elie Kantor, Jean-Michel Constantin, Jean-Yves Lefrant, Thomas Lescot, Nicolas Nesseler, Catherine Paugam, Matthieu Jabaudon and Hervé Dupont

Critical Care volume 23, Article number: 393 (2019)

Background:

Recent international guidelines for acute pancreatitis (AP) recommend limiting anti-infective therapy (AIT) to cases of suspected necrotizing AP or nosocomial extrapancreatic infection. Limited data are available concerning empirical and documented AIT prescribing practices in patients admitted to the intensive care unit (ICU) for the management of AP.

Methods:

Using a multicentre, retrospective (2009–2014), observational database of ICU patients admitted for AP, our primary objective was to assess the incidence of AIT prescribing practices during the first 30 days following admission. Secondary objectives were to assess the independent impact of centre characteristics on the incidence of AIT and to identify factors associated with crude hospital mortality in a logistic regression model.

Results:

In this cohort of 860 patients, 359 (42%) received AIT on admission. Before day 30, 340/359 (95%) AIT patients and 226/501 (45%) AIT-free patients on admission received additional AIT, mainly for intra-abdominal and lung infections. A large heterogeneity was observed between centres in terms of the incidence of infections, therapeutic management including AIT and prognosis. Administration of AIT on admission or until day 30 was not associated with an increased mortality rate. Patients receiving AIT on admission had increased rates of complications (septic shock, intra-abdominal and pulmonary infections), therapeutic (surgical, percutaneous, endoscopic) interventions and increased length of ICU stay compared to AIT-free patients. Patients receiving delayed AIT after admission and until day 30 had increased rates of complications (respiratory distress syndrome, intra-abdominal and pulmonary infections), therapeutic interventions and increased length of ICU stay compared to those receiving AIT on admission. Risk factors for hospital mortality assessed on admission were age (adjusted odds ratio [95% confidence interval] 1.03 [1.02–1.05]; p < 0.0001), Balthazar score E (2.26 [1.43–3.56]; p < 0.0001), oliguria/anuria (2.18 [1.82–4.33]; p < 0.0001), vasoactive support (2.83 [1.73–4.62]; p < 0.0001) and mechanical ventilation (1.90 [1.15–3.14]; p = 0.011), but not AIT (0.63 [0.40–1.01]; p = 0.057).

Conclusions:

High proportions of ICU patients admitted for AP receive AIT, both on admission and during their ICU stay. A large heterogeneity was observed between centres in terms of incidence of infections, AIT prescribing practices, therapeutic management and outcome. AIT reflects the initial severity and complications of AP, but is not a risk factor for death.

Epidemiology of critically ill patients in intensive care units

Epidemiology of critically ill patients in intensive care units: A population-based observational study. Critical care, Sept 2013, Vol. 17(5), R:212

Garland, A., et al.

http://ccforum.com/content/17/5/R212

Epidemiologic assessment of critically ill people in Intensive Care Units (ICUs) is needed to ensure the health care system can meet current and future needs. However, few such studies have been published.