Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen.

IF 2.4 4区 医学 Q2 CRITICAL CARE MEDICINE
Respiratory care Pub Date : 2025-02-01 Epub Date: 2024-10-29 DOI:10.4187/respcare.11933
Shahin Isha, Gustavo Olaizola, Indalecio Carboni Bisso, Lekhya Raavi, Sadhana Jonna, Anna Jenkins, Abby Hanson, Rahul Kashyap, Veronica Monzon, Ivan A Huespe, Devang Sanghavi
{"title":"Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen.","authors":"Shahin Isha, Gustavo Olaizola, Indalecio Carboni Bisso, Lekhya Raavi, Sadhana Jonna, Anna Jenkins, Abby Hanson, Rahul Kashyap, Veronica Monzon, Ivan A Huespe, Devang Sanghavi","doi":"10.4187/respcare.11933","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> Nine hundred sixty-five non-intubated subjects with ARDS were included, of whom 27% (<i>n =</i> 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) (<i>n</i> = 225), and among subjects who progressed to the Berlin criteria, it was 37% (95% CI 31-43) (<i>n</i> = 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) (<i>n =</i> 177) for subjects with S<sub>pO<sub>2</sub></sub>/F<sub>IO<sub>2</sub></sub> ≤148, 17% (95% CI 12-23) (<i>n =</i> 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) (<i>n =</i> 10) for subjects maintaining an S<sub>pO<sub>2</sub></sub>/F<sub>IO<sub>2</sub></sub> higher than 235 (<i>P</i> < .001). <b>Conclusions:</b> 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.</p>","PeriodicalId":21125,"journal":{"name":"Respiratory care","volume":" ","pages":"119-125"},"PeriodicalIF":2.4000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Respiratory care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4187/respcare.11933","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/29 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

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 SpO2/FIO2 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 SpO2/FIO2 ≤315 [with SpO2 ≤97%] or a PaO2/FIO2 ≤300 mm Hg while receiving ≥30 L/min O2 via HFNC) were included. The study evaluated the proportion of subjects who progressed to intubation, severity levels using the SpO2/FIO2 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 SpO2/FIO2 within 1 d of ARDS diagnosis was correlated with mortality, with mortality rates of 26% (95% CI 23-30) (n = 177) for subjects with SpO2/FIO2 ≤148, 17% (95% CI 12-23) (n = 38) for those with SpO2/FIO2 between 149-234, and 16% (95% CI 8-28) (n = 10) for subjects maintaining an SpO2/FIO2 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 SpO2/FIO2 and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.

评估使用高流量鼻氧治疗的 COVID-19 住院患者中新提出的 ARDS 定义。
背景:ARDS 的新全球定义最近引入了一个称为非插管 ARDS 的亚组。本研究旨在根据非插管 ARDS 患者的 SpO2 /FIO2 评估从无创氧气支持发展到插管的风险以及 ARDS 的严重程度:这项回顾性研究纳入了2020年1月至2023年1月期间在7家医院(5家在美国,2家在阿根廷)住院的COVID-19受试者。研究对象符合新的非插管 ARDS 定义(高流量鼻插管 [HFNC],SpO2 /FIO2 ≤ 315 [SpO2≤97%]或 PaO2 /FIO2 ≤ 300 mm Hg,同时通过 HFNC 接受≥30 L/min 的氧气)。研究评估了进展到插管的受试者比例、使用新 ARDS 定义中提出的 SpO2 /FIO2 临界值的严重程度以及死亡率:研究共纳入了965名未插管的ARDS患者,其中27%(n = 262)的患者在中位3天内(四分位距为2-6)达到了柏林标准。总死亡率为 23% (95% CI 20-26) (n = 225),在进展到柏林标准的受试者中,总死亡率为 37% (95% CI 31-43) (n = 98)。此外,ARDS 诊断后 1 d 内最差 SpO2 /FIO2 与死亡率相关,SpO2 /FIO2 ≤ 148 的受试者死亡率为 26% (95% CI 23-30) (n = 177),SpO2 /FIO2 在 149-234 之间的受试者死亡率为 17% (95% CI 12-23) (n = 38),SpO2 /FIO2 超过 235 的受试者死亡率为 16% (95% CI 8-28) (n = 10)(P < .001):结论:与柏林标准相比,非插管 ARDS 标准涵盖的受试者范围更广,院内死亡率更低。全球 ARDS 新定义中提出的 SpO2 /FIO2 和 ARDS 严重程度临界值是预测这些受试者院内死亡率的重要指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Respiratory care
Respiratory care 医学-呼吸系统
CiteScore
4.70
自引率
16.00%
发文量
209
审稿时长
1 months
期刊介绍: RESPIRATORY CARE is the official monthly science journal of the American Association for Respiratory Care. It is indexed in PubMed and included in ISI''s Web of Science.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信