Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study

Rachael L Parke; Shay P McGuinness; Alana Cavadino; Keri-Anne Cowdrey; Samantha Bates; Shailesh Bihari; Amanda Corley; Eileen Gilder; Carol Hodgson; Edward Litton; Colin McArthur; Alistair Nichol; Jane Parker; Anne Turner; Steve Webb; Frank Mp Van Haren; SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group

doi:10.1016/j.ccrj.2024.05.001

Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study

Crit Care Resusc. 2024 Jun 21;26(3):161-168. doi: 10.1016/j.ccrj.2024.05.001. eCollection 2024 Sep.

Authors

Rachael L Parke^{1

2

3

4}, Shay P McGuinness^{1

3

4}, Alana Cavadino⁵, Keri-Anne Cowdrey¹, Samantha Bates^{6

7}, Shailesh Bihari^{8

9}, Amanda Corley^{10

11

12}, Eileen Gilder^{1

2}, Carol Hodgson^{4

13}, Edward Litton^{14

15}, Colin McArthur^{3

16}, Alistair Nichol^{4

17}, Jane Parker⁴, Anne Turner³, Steve Webb⁴, Frank Mp Van Haren^{18

19}; SAGE-ANZ Study Investigators and the Australia and New Zealand Intensive Care Society Clinical Trials Group

Affiliations

¹ Cardiothoracic and Vascular Intensive Care Unit, Te Toka Tumai Auckland, Auckland, New Zealand.
² School of Nursing, The University of Auckland, Auckland, New Zealand.
³ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁴ Australian and New Zealand Intensive Care Centre, Monash University, Melbourne, Australia.
⁵ School of Population Health, The University of Auckland, Auckland, New Zealand.
⁶ Department of Intensive Care, Western Health, VIC, Australia.
⁷ Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.
⁸ College of Medicine and Public Health, Flinders University, Bedford Park, South Australia 5042, Australia.
⁹ Department of ICCU, Flinders Medical Centre, Bedford Park, South Australia 5042, Australia.
¹⁰ Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.
¹¹ School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, Australia.
¹² School of Nursing, Midwifery and Social Work, University of Queensland, Australia.
¹³ Intensive Care Unit, Alfred Hospital, Melbourne, Australia.
¹⁴ Intensive Care Unit, Fiona Stanley Hospital, Perth Australia.
¹⁵ School of Medicine, University of Western Australia, Crawley, Australia.
¹⁶ Department of Critical Care Medicine, Te Toka Tumai Auckland, Auckland, New Zealand.
¹⁷ University College Dublin-Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland.
¹⁸ Intensive Care Unit, St George Hospital, Sydney, Australia.
¹⁹ College of Health and Medicine, Australian National University, Canberra, Australia.

Abstract

Objective: Acute respiratory distress syndrome (ARDS) is associated with significant mortality, morbidity, and cost. We aimed to describe characteristics and management of adult patients admitted to intensive care units (ICUs) in Australia and New Zealand with moderate-severe ARDS, to better understand contemporary practice.

Design: Bi-national, prospective, observational, multi-centre study.

Setting: 19 ICUs in Australia and New Zealand.

Participants: Mechanically ventilated patients with moderate-severe ARDS.

Main outcome measures: Baseline demographic characteristics, ventilation characteristics, use of adjunctive support therapy and all-cause mortality to day 28. Data were summarised using descriptive statistics.

Results: 200 participants were enrolled, mean (±SD) age 55.5 (±15.9) years, 40% (n = 80) female. Around half (51.5%) had no baseline comorbidities and 45 (31%) tested positive for COVID-19. On day 1, mean SOFA score was 9 ± 3; median (IQR) PaO₂/FiO₂ ratio 119 (89, 142), median (IQR) FiO₂ 70% (50%, 99%) and mean (±SD) positive end expiratory pressure (PEEP) 11 (±3) cmH₂O. On day one, 10.5% (n = 21) received lung protective ventilation (LPV) (tidal volume ≤6.5 mL/kg predicted body weight and plateau pressure or peak pressure ≤30 cm H₂O). Adjunctive therapies were received by 86% (n = 172) of patients at some stage from enrolment to day 28. Systemic steroids were most used (n = 127) followed by neuromuscular blockers (n = 122) and prone positioning (n = 27). Median ventilator-free days (IQR) to day 28 was 5 (0, 20). In-hospital mortality, censored at day 28, was 30.5% (n = 61).

Conclusions: In Australia and New Zealand, compliance with evidence-based practices including LPV and prone positioning was low in this cohort. Therapies with proven benefit in the treatment of patients with moderate-severe ARDS, such as lung protective ventilation and prone positioning, were not routinely employed.

Keywords: Acute respiratory distress syndrome: adjunctive therapy; Lung protective ventilation; Mechanical ventilation; Prone positioning.