The Predictive Validity of the Berlin Definition of Acute Respiratory Distress Syndrome for Patients With COVID-19-Related Respiratory Failure Treated With High-Flow Nasal Oxygen: A Multicenter, Prospective Cohort Study.

Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0355501 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1530-0293 (Electronic) Linking ISSN: 00903493 NLM ISO Abbreviation: Crit Care Med Subsets: MEDLINE

Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen.

COVID-19*/complications ; COVID-19*/therapy ; Respiratory Distress Syndrome*/diagnosis ; Respiratory Distress Syndrome*/therapy ; Respiratory Insufficiency*/diagnosis ; Respiratory Insufficiency*/etiology ; Respiratory Insufficiency*/therapy; Humans ; Prospective Studies ; Oxygen ; Reproducibility of Results

Objectives: The Berlin definition of acute respiratory distress syndrome (ARDS) was constructed for patients receiving invasive mechanical ventilation (IMV) with consideration given to issues related to reliability, feasibility, and validity. Notwithstanding, patients with acute respiratory failure (ARF) may be treated with high-flow nasal oxygen (HFNO) and may not fall within the scope of the original definition. We aimed to evaluate the predictive validity of the Berlin definition in HFNO-treated patients with COVID-19-related respiratory failure who otherwise met ARDS criteria.
Design: Multicenter, prospective cohort study.
Setting: Five ICUs of five centers in Argentina from March 2020 to September 2021.
Patients: We consecutively included HFNO-treated patients older than 18 years with confirmed COVID-19-related ARF, a Pa o2 /F io2 of less than 300 mm Hg, bilateral infiltrates on imaging, and worsening respiratory symptoms for less than 1 week.
Interventions: None.
Measurements and Main Results: We evaluated the predictive validity of mortality at day 28 using the area under the receiver operating characteristics curve (AUC), compared the predictive validity across subgroups, and characterized relevant clinical outcomes. We screened 1,231 patients and included 696 ARDS patients [30 (4%) mild, 380 (55%) moderate, and 286 (41%) severe]. For the study cohort, the AUC for mortality at day 28 was 0.606 (95% CI, 0.561-0.651) with the AUC for subgroups being similar to that of the overall cohort. Two hundred fifty-six patients (37%) received IMV. By day 28, 142 patients (21%) had died, of whom 81 (57%) had severe ARDS. Mortality occurred primarily in patients who were transitioned to IMV.
Conclusions: The predictive validity of the Berlin ARDS definition was similar for HFNO-treated patients as compared with the original population of invasively ventilated patients. Our findings support the extension of the Berlin definition to HFNO-treated patients with ARDS.
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

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Investigator: J Osatnik, Intensive Care Unit, Hospital Aleman, Universidad del Salvador.; SN Saavedra, Intensive Care Unit, Hospital Aleman, Universidad del Salvador.; A Matarrese, Intensive Care Unit, Hospital Aleman, Universidad del Salvador.; EG Wasinger, Intensive Care Unit, Hospital Universitario Austral, Universidad Austral.; FJ Andrada, Intensive Care Unit, Hospital Universitario Austral, Universidad Austral.; G Mast, Intensive Care Unit, Hospital Universitario Austral, Universidad Austral.; H Kakisu, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; CN Moreno, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; V Barbaresi, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; AM Tirado, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; JM Pintos, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; MC Viñas, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; ME Gonzalez, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; M Mateos, Intensive Care Unit, Hospital Privado de Comunidad, Universidad Nacional de Mar del Plata.; AI Lagazio, Intensive Care Unit, Sanatorio de la Trinidad Palermo.; MA Mogaadouro, Intensive Care Unit, Sanatorio de la Trinidad Palermo.; MR Seifert, Intensive Care Unit, Sanatorio de la Trinidad Palermo.; E Mastroberti, Intensive Care Unit, Sanatorio de la Trinidad Palermo.; NE Romano, Intensive Care Unit, Clínica Olivos SMG, Olivos Buenos Aires Argentina.; MM Laiz, Intensive Care Unit, Clínica Olivos SMG, Olivos Buenos Aires Argentina.; JG Urrutia, Intensive Care Unit, Clínica Olivos SMG, Olivos Buenos Aires Argentina.

ClinicalTrials.gov NCT05178212

S88TT14065 (Oxygen)

Date Created: 20231017 Date Completed: 20231216 Latest Revision: 20240206

20240207

10.1097/CCM.0000000000006056

37846935