Rethinking ARDS classification: oxygenation impairment fails to predict VILI risk

IF 27.1 1区 医学 Q1 CRITICAL CARE MEDICINE
Giulia Catozzi, Tommaso Pozzi, Domenico Nocera, Beatrice Donati, Stefano Giovanazzi, Valentina Ghidoni, Mauro Galizia, Rosanna D’Albo, Mattia Busana, Federica Romitti, Alessandro Gatta, Onnen Moerer, Konrad Meissner, Michael Quintel, Peter Herrmann, Davide Chiumello, Luigi Camporota, Luciano Gattinoni
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引用次数: 0

Abstract

Purpose

The selection and intensity of respiratory support for ARDS are guided by PaO2/FiO2. However, ventilator-induced lung injury (VILI) is linked to respiratory mechanics and ventilator settings. We explored whether the VILI risk is related to ARDS severity based on oxygenation.

Methods

We analysed data on 228 ARDS subjects with PaO2/FiO2 < 200 mmHg, categorized into three severity groups: one based on PaO2/FiO2 ratio, and the others based on tertiles of predictors of VILI: mechanical power ratio (MPR) and driving pressure (DP). In each group of oxygenation-based ARDS severity and MPR and DP tertiles, we measured CT anatomy, gas exchange, respiratory mechanics, VILI prerequisites (lung elastance and lung gas volume), and VILI determinants (tidal volume, PEEP, airway pressures).

Results

Predictors of VILI, such as MPR and DP, were similar across ARDS severity groups based on PaO2/FiO2 ratio, while oxygenation remained comparable across different levels of VILI risk defined by MPR and DP. Oxygenation impairment was associated with increased lung weight, recruitability, and reduced well-inflated tissue. In contrast, MPR and DP tertiles affected variables associated with the baby lung size, such as lung gas volume and well-inflated tissue. Mechanical ventilation intensity increased progressively across MPR and DP tertiles, but remained similar across PaO2/FiO2 severity groups.

Conclusions

ARDS severity based on oxygenation impairment does not reflect the prerequisites and determinants of VILI. This should prompt a reconsideration of recommending respiratory support based on oxygenation impairment, rather than VILI determinants.

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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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