tetano
Editor, Senior Moderator
Respir Care
. 2024 Oct 29:respcare.11933.
doi: 10.4187/respcare.11933. Online ahead of print. Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen
Isha Shahin[SUP] 1 [/SUP], Gustavo Olaizola[SUP] 2 [/SUP], Indalecio Carboni Bisso[SUP] 3 [/SUP], Lekhya Raavi[SUP] 1 [/SUP], Sadhana Jonna[SUP] 1 [/SUP], Anna Jenkins[SUP] 1 [/SUP], Abby Hanson[SUP] 1 [/SUP], Rahul Kashyap[SUP] 4 [/SUP], Veronica Monzon[SUP] 4 [/SUP], Ivan Huespe[SUP] 5 [/SUP], Devang Sanghavi[SUP] 1 [/SUP]
Affiliations
Background: The new Global definition of ARDS recently introduced a subgroup known as non-intubated ARDS. This study aimed to assess the risk of progression from noninvasive oxygen support to intubation and ARDS severity based on the S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] among non-intubated subjects with ARDS.
Methods: This retrospective study included subjects with COVID-19 admitted to 7 hospitals (5 in the United States and 2 in Argentina) from January 2020-January 2023. Subjects meeting the new non-intubated ARDS definition (high-flow nasal cannula [HFNC] with an S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ≤ 315 [with S[SUB]pO[SUB]2[/SUB][/SUB] ≤ 97%] or a P[SUB]aO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ≤ 300 mm Hg while receiving ≥30 L/min O[SUB]2[/SUB] via HFNC) were included. The study evaluated the proportion of subjects who progressed to intubation, severity levels using the S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] cutoff proposed in the new ARDS definition, and mortality.
Results: Nine hundred sixty-five non-intubated subjects with ARDS were included, of whom 27% (n = 262) progressed to meet the Berlin criteria within a median of 3 d (interquartile range 2-6). The overall mortality was 23% (95% CI 20-26) (n = 225), and among subjects who progressed to the Berlin criteria, it was 37% (95% CI 31-43) (n = 98). Additionally, the worst S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] within 1 d of ARDS diagnosis was correlated with mortality, with mortality rates of 26% (95% CI 23-30) (n = 177) for subjects with S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ≤ 148, 17% (95% CI 12-23) (n = 38) for those with S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] between 149-234, and 16% (95% CI 8-28) (n = 10) for subjects maintaining an S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] higher than 235 (P < .001).
Conclusions: The non-intubated ARDS criteria encompassed a broader spectrum of subjects with lower in-hospital mortality compared to the Berlin criteria. The S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.
Keywords: ARDS; coronavirus disease 2019; critical care; high-flow nasal cannula oxygen; oxygen saturation.
. 2024 Oct 29:respcare.11933.
doi: 10.4187/respcare.11933. Online ahead of print. Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen
Isha Shahin[SUP] 1 [/SUP], Gustavo Olaizola[SUP] 2 [/SUP], Indalecio Carboni Bisso[SUP] 3 [/SUP], Lekhya Raavi[SUP] 1 [/SUP], Sadhana Jonna[SUP] 1 [/SUP], Anna Jenkins[SUP] 1 [/SUP], Abby Hanson[SUP] 1 [/SUP], Rahul Kashyap[SUP] 4 [/SUP], Veronica Monzon[SUP] 4 [/SUP], Ivan Huespe[SUP] 5 [/SUP], Devang Sanghavi[SUP] 1 [/SUP]
Affiliations
- PMID: 39472067
- DOI: 10.4187/respcare.11933
Background: The new Global definition of ARDS recently introduced a subgroup known as non-intubated ARDS. This study aimed to assess the risk of progression from noninvasive oxygen support to intubation and ARDS severity based on the S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] among non-intubated subjects with ARDS.
Methods: This retrospective study included subjects with COVID-19 admitted to 7 hospitals (5 in the United States and 2 in Argentina) from January 2020-January 2023. Subjects meeting the new non-intubated ARDS definition (high-flow nasal cannula [HFNC] with an S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ≤ 315 [with S[SUB]pO[SUB]2[/SUB][/SUB] ≤ 97%] or a P[SUB]aO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ≤ 300 mm Hg while receiving ≥30 L/min O[SUB]2[/SUB] via HFNC) were included. The study evaluated the proportion of subjects who progressed to intubation, severity levels using the S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] cutoff proposed in the new ARDS definition, and mortality.
Results: Nine hundred sixty-five non-intubated subjects with ARDS were included, of whom 27% (n = 262) progressed to meet the Berlin criteria within a median of 3 d (interquartile range 2-6). The overall mortality was 23% (95% CI 20-26) (n = 225), and among subjects who progressed to the Berlin criteria, it was 37% (95% CI 31-43) (n = 98). Additionally, the worst S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] within 1 d of ARDS diagnosis was correlated with mortality, with mortality rates of 26% (95% CI 23-30) (n = 177) for subjects with S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] ≤ 148, 17% (95% CI 12-23) (n = 38) for those with S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] between 149-234, and 16% (95% CI 8-28) (n = 10) for subjects maintaining an S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] higher than 235 (P < .001).
Conclusions: The non-intubated ARDS criteria encompassed a broader spectrum of subjects with lower in-hospital mortality compared to the Berlin criteria. The S[SUB]pO[SUB]2[/SUB][/SUB] /F[SUB]IO[SUB]2[/SUB][/SUB] and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.
Keywords: ARDS; coronavirus disease 2019; critical care; high-flow nasal cannula oxygen; oxygen saturation.