التفاصيل البيبلوغرافية
| العنوان: |
Respiratory Subsets in Patients with Moderate to Severe Acute Respiratory Distress Syndrome for Early Prediction of Death |
| المؤلفون: |
Jesús Villar, Cristina Fernández, Jesús M. González-Martín, Carlos Ferrando, José M. Añón, Ana M. del Saz-Ortíz, Ana Díaz-Lamas, Ana Bueno-González, Lorena Fernández, Ana M. Domínguez-Berrot, Eduardo Peinado, David Andaluz-Ojeda, Elena González-Higueras, Anxela Vidal, M. Mar Fernández, Juan M. Mora-Ordoñez, Isabel Murcia, Concepción Tarancón, Eleuterio Merayo, Alba Pérez, Miguel A. Romera, Francisco Alba, David Pestaña, Pedro Rodríguez-Suárez, Rosa L. Fernández, Ewout W. Steyerberg, Lorenzo Berra, Arthur S. Slutsky, The Spanish Initiative for Epidemiology |
| المصدر: |
Journal of Clinical Medicine, Vol 11, Iss 5724, p 5724 (2022) |
| بيانات النشر: |
MDPI AG |
| سنة النشر: |
2022 |
| مصطلحات موضوعية: |
lung-protective ventilation, mortality, stratification, ARDS criteria, prediction, outcome, Medicine, demo, envir |
| الوصف: |
Introduction: In patients with acute respiratory distress syndrome (ARDS), the PaO 2 /FiO 2 ratio at the time of ARDS diagnosis is weakly associated with mortality. We hypothesized that setting a PaO 2 /FiO 2 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 PaO 2 /FiO 2 (150 mm Hg) and positive end-expiratory pressure (PEEP) (10 cm H 2 O), the patients were classified into four possible subsets at baseline and at 24 h using a standardized PEEP-FiO 2 approach: (I) PaO 2 /FiO 2 ≥ 150 at PEEP < 10, (II) PaO 2 /FiO 2 ≥ 150 at PEEP ≥ 10, (III) PaO 2 /FiO 2 < 150 at PEEP < 10, and (IV) PaO 2 /FiO 2 < 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 PaO 2 /FiO 2 < 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 PaO 2 /FiO 2 < 150 at 24 h followed a distinct 30-day ICU survival compared with patients with PaO 2 /FiO 2 ≥ 150 (hazard ratio 2.8, 95% CI 2.2–3.5, p < 0.0001). Conclusions: Subsets based on PaO 2 /FiO 2 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 ... |
| نوع الوثيقة: |
article in journal/newspaper |
| اللغة: |
English |
| العلاقة: |
https://doi.org/10.3390/jcm11195724Test |
| DOI: |
10.3390/jcm11195724 |
| الإتاحة: |
https://doi.org/10.3390/jcm11195724Test |
| حقوق: |
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| رقم الانضمام: |
edsbas.5E303961 |
| قاعدة البيانات: |
BASE |
