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。

IF 2.4 4区医学 Q2 CRITICAL CARE MEDICINE

Respiratory care Pub Date : 2024-10-31 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 Huespe, Devang Sanghavi

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引用次数: 0

摘要

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。

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

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_pO₂ /F_IO₂ 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_pO₂ /F_IO₂ ≤ 315 [with S_pO₂ ≤ 97%] or a P_aO₂ /F_IO₂ ≤ 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 S_pO₂ /F_IO₂ 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_pO₂ /F_IO₂ 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_pO₂ /F_IO₂ ≤ 148, 17% (95% CI 12-23) (n = 38) for those with S_pO₂ /F_IO₂ between 149-234, and 16% (95% CI 8-28) (n = 10) for subjects maintaining an S_pO₂ /F_IO₂ 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_pO₂ /F_IO₂ and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.

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来源期刊

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.