Respiratory Subsets in Patients with Moderate to Severe Acute Respiratory Distress Syndrome for Early Prediction of Death.
Respiratory Subsets in Patients with Moderate to Severe Acute Respiratory Distress Syndrome for Early Prediction of Death.
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DOI：
10.3390/jcm11195724
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发表时间：
2022-09-27
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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简介：在急性呼吸窘迫综合征（ARDS）患者中，ARDS诊断时的PaO 2/FiO 2比值与死亡率相关性较弱。我们假设，在中/重度ARDS诊断后24小时将PaO 2/FiO 2阈值设定为150 mmHg将改善重症监护室（ICU）死亡的预测。研究方法：我们在ICU网络中的4个前瞻性多中心队列中连续招募了1303例接受肺保护性通气治疗的中重度ARDS患者进行了一项辅助研究。将前三个队列合并（n = 1000）作为检测队列;第四个队列（n = 303）作为确证性队列。基于PaO 2/FiO 2的阈值（150 mm Hg）和呼气末正压（PEEP）（10 cm H2O）时，使用标准化PEEP-FiO 2方法将患者在基线和24 h时分为四个可能的亚组：（I）PEEP < 10时PaO 2/FiO 2 ≥ 150，（II）PEEP ≥ 10时PaO 2/FiO 2 ≥ 150，（III）PEEP < 10时PaO 2/FiO 2 < 150，（IV）PEEP ≥ 10时PaO 2/FiO 2 < 150。主要结局为ICU死亡。结果：试验组和确证组的ICU死亡率相似（分别为375/1000，37.5%和112/303，37.0%）。在基线时，来自测试队列的大多数患者（n = 792/1000，79.2%）的PaO 2/FiO 2 < 150，四个亚组的死亡率相似（p = 0.23）。当在24小时评估时，ICU死亡率随着亚组的进展而增加：17.9%，22.8%，40.0%和49.3%（p < 0.0001）。这些发现在验证性队列中重复（p < 0.0001）。然而，与PEEP水平无关，与PaO 2/FiO 2 ≥ 150的患者相比，24 h时PaO 2/FiO 2 <150的患者的ICU 30天生存率明显更高（风险比2.8，95% CI 2.2-3.5，p < 0.0001）。结论：基于PaO 2/FiO 2阈值150 mm Hg的亚组在中度/重度ARDS诊断24小时后评估，与建立预后具有临床相关性，有助于选择低氧血症的预防性治疗和将患者纳入治疗试验。
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.
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影响因子：
8.8
作者：
Metkus TS;Guallar E;Sokoll L;Morrow D;Tomaselli G;Brower R;Schulman S;Korley FK
通讯作者：
Korley FK
影响因子：
9.6
作者：
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通讯作者：
URSPRUNG, JJ
影响因子：
120.7
作者：
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通讯作者：
Ribeiro de Carvalho, Carlos Roberto
影响因子：
158.5
作者：
Papazian, Laurent;Forel, Jean-Marie;Roch, Antoine
通讯作者：
Roch, Antoine
影响因子：
38.9
作者：
Juschten J;Tuinman PR;Guo T;Juffermans NP;Schultz MJ;Loer SA;Girbes ARJ;de Grooth HJ
通讯作者：
de Grooth HJ