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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.
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- Author(s): Busico M;Busico M; Fuentes NA; Fuentes NA; Gallardo A; Gallardo A; Vitali A; Vitali A; Quintana J; Quintana J; Olmos M; Olmos M; Burns KEA; Burns KEA; Burns KEA; Esperatti M; Esperatti M
- Source:
Critical care medicine [Crit Care Med] 2024 Jan 01; Vol. 52 (1), pp. 92-101. Date of Electronic Publication: 2023 Oct 16.- Publication Type:
Multicenter Study; Journal Article- Language:
English - Source:
- Additional Information
- Corporate Authors:
- Source: 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 Information: Publication: Philadelphia, PA : Lippincott Williams & Wilkins
Original Publication: New York, Kolen. - Subject Terms: 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
- Abstract: 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.
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- Molecular Sequence: ClinicalTrials.gov NCT05178212
- Accession Number: S88TT14065 (Oxygen)
- Publication Date: Date Created: 20231017 Date Completed: 20231216 Latest Revision: 20240206
- Publication Date: 20240207
- Accession Number: 10.1097/CCM.0000000000006056
- Accession Number: 37846935
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