Respiratory Subsets in Patients with Moderate to Severe Acute Respiratory Distress Syndrome for Early Prediction of Death

Introduction: In patients with acute respiratory distress syndrome (ARDS), the PaO2/FiO2 ratio at the time of ARDS diagnosis is weakly associated with mortality. We hypothesized that setting a PaO2/FiO2 threshold in 150 mm Hg at 24 h from moderate/severe ARDS diagnosis would improve predictions of d...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical medicine Vol. 11; no. 19; p. 5724
Main Authors: Villar, Jesús, Fernández, Cristina, González-Martín, Jesús M, Ferrando, Carlos, Añón, José M, Del Saz-Ortíz, Ana M, Díaz-Lamas, Ana, Bueno-González, Ana, Fernández, Lorena, Domínguez-Berrot, Ana M, Peinado, Eduardo, Andaluz-Ojeda, David, González-Higueras, Elena, Vidal, Anxela, Fernández, M Mar, Mora-Ordoñez, Juan M, Murcia, Isabel, Tarancón, Concepción, Merayo, Eleuterio, Pérez, Alba, Romera, Miguel A, Alba, Francisco, Pestaña, David, Rodríguez-Suárez, Pedro, Fernández, Rosa L, Steyerberg, Ewout W, Berra, Lorenzo, Slutsky, Arthur S, The Spanish Initiative For Epidemiology Stratification And Therapies Of Ards Siesta Network
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 27-09-2022
MDPI
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction: In patients with acute respiratory distress syndrome (ARDS), the PaO2/FiO2 ratio at the time of ARDS diagnosis is weakly associated with mortality. We hypothesized that setting a PaO2/FiO2 threshold in 150 mm Hg at 24 h from moderate/severe ARDS diagnosis would improve predictions of death in the intensive care unit (ICU). Methods: We conducted an ancillary study in 1303 patients with moderate to severe ARDS managed with lung-protective ventilation enrolled consecutively in four prospective multicenter cohorts in a network of ICUs. The first three cohorts were pooled (n = 1000) as a testing cohort; the fourth cohort (n = 303) served as a confirmatory cohort. Based on the thresholds for PaO2/FiO2 (150 mm Hg) and positive end-expiratory pressure (PEEP) (10 cm H2O), the patients were classified into four possible subsets at baseline and at 24 h using a standardized PEEP-FiO2 approach: (I) PaO2/FiO2 ≥ 150 at PEEP < 10, (II) PaO2/FiO2 ≥ 150 at PEEP ≥ 10, (III) PaO2/FiO2 < 150 at PEEP < 10, and (IV) PaO2/FiO2 < 150 at PEEP ≥ 10. Primary outcome was death in the ICU. Results: ICU mortalities were similar in the testing and confirmatory cohorts (375/1000, 37.5% vs. 112/303, 37.0%, respectively). At baseline, most patients from the testing cohort (n = 792/1000, 79.2%) had a PaO2/FiO2 < 150, with similar mortality among the four subsets (p = 0.23). When assessed at 24 h, ICU mortality increased with an advance in the subset: 17.9%, 22.8%, 40.0%, and 49.3% (p < 0.0001). The findings were replicated in the confirmatory cohort (p < 0.0001). However, independent of the PEEP levels, patients with PaO2/FiO2 < 150 at 24 h followed a distinct 30-day ICU survival compared with patients with PaO2/FiO2 ≥ 150 (hazard ratio 2.8, 95% CI 2.2−3.5, p < 0.0001). Conclusions: Subsets based on PaO2/FiO2 thresholds of 150 mm Hg assessed after 24 h of moderate/severe ARDS diagnosis are clinically relevant for establishing prognosis, and are helpful for selecting adjunctive therapies for hypoxemia and for enrolling patients into therapeutic trials.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
Members of the SIESTA network are listed in the Appendix A.
These authors contributed equally to this work.
To the memory of Robert M. Kacmarek.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm11195724