RT Journal Article
SR Electronic
T1 Evaluating the Newly Proposed ARDS Definition in Hospitalized Patients With COVID-19 Treated With High-Flow Nasal Oxygen
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.11933
DO 10.4187/respcare.11933
A1 Isha, Shahin
A1 Olaizola, Gustavo
A1 Carboni Bisso, Indalecio
A1 Raavi, Lekhya
A1 Jonna, Sadhana
A1 Jenkins, Anna
A1 Hanson, Abby
A1 Kashyap, Rahul
A1 Monzon, Veronica
A1 Huespe, Ivan
A1 Sanghavi, Devang
YR 2024
UL http://rc.rcjournal.com/content/early/2024/10/31/respcare.11933.abstract
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.