Early Identification of Acute Respiratory Distress Syndrome in the Absence of Positive Pressure Ventilation: Implications for Revision of the Berlin Criteria for Acute Respiratory Distress Syndrome
Early Identification of Acute Respiratory Distress Syndrome in the Absence of Positive Pressure Ventilation: Implications for Revision of the Berlin Criteria for Acute Respiratory Distress Syndrome
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DOI：
10.1097/ccm.0000000000002929
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发表时间：
2018-04-01
影响因子：
8.8
通讯作者：
Thille, Arnaud W.
中科院分区：
文献类型：
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作者：
Coudroy, Remi;Frat, Jean-Pierre;Thille, Arnaud W.
目的：评价标准氧下自主呼吸的患者是否能按照现行柏林定义早期识别为急性呼吸窘迫综合征患者。设计：对两项前瞻性研究进行事后分析。设置：23个法国icu。患者：对所有因急性低氧性呼吸衰竭入院并接受无创通气治疗的患者进行分析。排除心源性肺水肿、慢性阻塞性肺疾病急性加重或高碳酸血症患者。干预措施:没有。测量和主要结果：入院时在标准氧条件下估计Pao(2)/Fio(2)比率，然后在起始后1小时和最初24小时内进行无创通气。219例采用无创通气治疗急性低氧性呼吸衰竭患者中，180例（82%）有双侧浸润，其中161例标准氧下Pao(2)/Fio(2)小于或等于300 mm Hg。其中127例患者呼气末正压≥5 cm H2O， 120例（94%）患者在24小时内达到急性呼吸窘迫综合征标准。双侧浸润且Pao2/Fio2≤300 mm Hg的患者在标准氧条件下的死亡率为29%，与柏林定义中插管急性呼吸窘迫综合征患者的死亡率非常接近。结论：几乎所有双侧肺浸润、标准氧条件下Pao(2)/Fio(2)≤300 mm Hg的患者在无创通气条件下24小时内均符合急性呼吸窘迫综合征标准。他们的死亡率与柏林报告的急性呼吸窘迫综合征的定义相似。因此，自发呼吸患者的急性呼吸窘迫综合征标准可以早期识别，无需正压通气。
Objectives: To assess whether patients breathing spontaneously under standard oxygen could be recognized early as acute respiratory distress syndrome patients according to the current Berlin definition.Design: A post hoc analysis from two prospective studies.Setting: Twenty-three French ICUs.Patients: All patients admitted for acute hypoxemic respiratory failure and treated with noninvasive ventilation were analyzed. Patients with cardiogenic pulmonary edema, acute exacerbation of chronic obstructive pulmonary disease, or hypercapnia were excluded.Interventions: None.Measurements and Main Results: The Pao(2)/Fio(2) ratio was estimated at admission under standard oxygen and then under non-invasive ventilation 1 hour after initiation and within the first 24 hours. Among the 219 patients treated with noninvasive ventilation for acute hypoxemic respiratory failure, 180 (82%) had bilateral infiltrates including 161 patients with Pao(2)/Fio(2) less than or equal to 300 mm Hg under standard oxygen. Among them, 127 were treated with positive end-expiratory pressure of at least 5 cm H2O, and 120 (94%) fulfilled criteria for acute respiratory distress syndrome within the first 24 hours. The mortality rate of patients with bilateral infiltrates and Pao2/Fio2 less than or equal to 300 mm Hg under standard oxygen was 29%, a rate very close to that of intubated patients with acute respiratory distress syndrome in the Berlin definition.Conclusions: Almost all patients with pulmonary bilateral infiltrates and a Pao(2)/Fio(2) less than or equal to 300 mm Hg under standard oxygen fulfilled the acute respiratory distress syndrome criteria under noninvasive ventilation within the first 24 hours. Their mortality rate was similar to that reported in the Berlin definition of acute respiratory distress syndrome. Therefore, spontaneous breathing patients with the acute respiratory distress syndrome criteria could be identified early without positive pressure ventilation.