PT  - JOURNAL ARTICLE
AU  - Isha, Shahin
AU  - Olaizola, Gustavo
AU  - Carboni Bisso, Indalecio
AU  - Raavi, Lekhya
AU  - Jonna, Sadhana
AU  - Jenkins, Anna
AU  - Hanson, Abby
AU  - Kashyap, Rahul
AU  - Monzon, Veronica
AU  - Huespe, Ivan
AU  - Sanghavi, Devang
TI  - Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen
AID  - 10.4187/respcare.11933
DP  - 2024 Oct 29
TA  - Respiratory Care
PG  - respcare.11933
4099  - http://rc.rcjournal.com/content/early/2024/10/31/respcare.11933.short
4100  - http://rc.rcjournal.com/content/early/2024/10/31/respcare.11933.full
AB  - BACKGROUND: The new Global definition of ARDS recently introduced a subgroup known as non-intubated ARDS. This study aimed to assess the risk of progression from noninvasive oxygen support to intubation and ARDS severity based on the SpO2/FIO2 among non-intubated subjects with ARDS.METHODS: This retrospective study included subjects with COVID-19 admitted to 7 hospitals (5 in the United States and 2 in Argentina) from January 2020–January 2023. Subjects meeting the new non-intubated ARDS definition (high-flow nasal cannula [HFNC] with an SpO2/FIO2 ≤ 315 [with SpO2 ≤ 97%] or a PaO2/FIO2 ≤ 300 mm Hg while receiving ≥30 L/min O2 via HFNC) were included. The study evaluated the proportion of subjects who progressed to intubation, severity levels using the SpO2/FIO2 cutoff proposed in the new ARDS definition, and mortality.RESULTS: Nine hundred sixty-five non-intubated subjects with ARDS were included, of whom 27% (n = 262) progressed to meet the Berlin criteria within a median of 3 d (interquartile range 2–6). The overall mortality was 23% (95% CI 20–26) (n = 225), and among subjects who progressed to the Berlin criteria, it was 37% (95% CI 31–43) (n = 98). Additionally, the worst SpO2/FIO2 within 1 d of ARDS diagnosis was correlated with mortality, with mortality rates of 26% (95% CI 23–30) (n = 177) for subjects with SpO2/FIO2 ≤ 148, 17% (95% CI 12–23) (n = 38) for those with SpO2/FIO2 between 149–234, and 16% (95% CI 8–28) (n = 10) for subjects maintaining an SpO2/FIO2 higher than 235 (P < .001).CONCLUSIONS: The non-intubated ARDS criteria encompassed a broader spectrum of subjects with lower in-hospital mortality compared to the Berlin criteria. The SpO2/FIO2 and ARDS severity cutoff proposed in the new Global ARDS definition were valuable predictors of in-hospital mortality in these subjects.