The Berlin definition of acute respiratory distress syndrome: should patients receiving high-flow nasal oxygen be included?
The Berlin definition of acute respiratory distress syndrome: should patients receiving high-flow nasal oxygen be included?
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DOI：
10.1016/s2213-2600(21)00105-3
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Ware LB
中科院分区：
文献类型：
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作者：
Matthay MA;Thompson BT;Ware LB
2012年柏林急性呼吸窘迫综合征（ARDS）定义为与接受呼吸支持患者死亡率相关的三个初始动脉低氧血症水平提供了有效的支持。自2015年以来，高流量鼻氧（HFNO）已被广泛用于急性呼吸衰竭的有效治疗支持，最近用于严重COVID-19患者。我们建议将ARDS的柏林定义扩大到包括HFNO至少30 L/min且满足ARDS柏林定义的其他标准的患者。扩大定义将使ARDS的诊断更广泛适用，允许在综合征早期阶段识别患者，而不需要气管插管或正压通气，有利于早期干预措施的测试和与ARDS病程相关因素的研究。我们确定了在细化ARDS扩展定义时可以解决的关键问题，该定义的实施可能导致临床实践和患者临床结果的改善。
The 2012 Berlin definition of acute respiratory distress syndrome (ARDS) provided validated support for three levels of initial arterial hypoxaemia that correlated with mortality in patients receiving ventilatory support. Since 2015, high-flow nasal oxygen (HFNO) has become widely used as an effective therapeutic support for acute respiratory failure, most recently in patients with severe COVID-19. We propose that the Berlin definition of ARDS be broadened to include patients treated with HFNO of at least 30 L/min who fulfil the other criteria for the Berlin definition of ARDS. An expanded definition would make the diagnosis of ARDS more widely applicable, allowing patients at an earlier stage of the syndrome to be recognised, independent of the need for endotracheal intubation or positive-pressure ventilation, with benefits for the testing of early interventions and the study of factors associated with the course of ARDS. We identify key questions that could be addressed in refining an expanded definition of ARDS, the implementation of which could lead to improvements in clinical practice and clinical outcomes for patients.