National survey of outcomes and practices in acute respiratory distress syndrome in Singapore

by Shahla Siddiqui, Zudin Puthucheary, Jason Phua, Benjamin Ho, Jonathan Tan, Siau Chuin, Noelle Louise Lim, Chai Rick Soh, Chian Min Loo, Addy Y. H. Tan, Amartya Mukhopadhyay, Faheem Ahmed Khan, Azman Johan, Aik Hau Tan, Graeme MacLaren, Juvel Taculod, Blesilda Ramos, Tun Aung Han, Matthew E. Cove

In the past 20 years, our understanding of acute respiratory distress syndrome (ARDS) management has improved, but the worldwide incidence and current outcomes are unclear. The reported incidence is highly variable, and no studies specifically characterise ARDS epidemiology in Asia. This observation study aims to determine the incidence, mortality and management practices of ARDS in a high income South East Asian country.

We conducted a prospective, population based observational study in 6 public hospitals. During a one month period, we identified all ARDS patients admitted to public hospital intensive care units (ICU) in Singapore, according to the Berlin definition. Demographic information, clinical management data and ICU outcome data was collected.

A total of 904 adult patients were admitted to ICU during the study period and 15 patients met ARDS criteria. The unadjusted incidence of ARDS was 4.5 cases per 100,000 population, accounting for 1.25% of all ICU patients. Most patients were male (75%), Chinese (62%), had pneumonia (73%), and were admitted to a Medical ICU (56%). Management strategies varied across all ICUs. In-hospital mortality was 40% and median length of ICU stay was 7 days.

The incidence of ARDS in a developed S.E Asia country is comparable to reported rates in European studies.