| A universal definition of ARDS: the PaO(2)/FiO (2) ratio under a standard ventilatory setting-a prospective, multicenter validation study. | |
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MedLine Citation:
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PMID: 23370826 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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PURPOSE: The PaO(2)/FiO(2) is an integral part of the assessment of patients with acute respiratory distress syndrome (ARDS). The American-European Consensus Conference definition does not mandate any standardization procedure. We hypothesized that the use of PaO(2)/FiO(2) calculated under a standard ventilatory setting within 24 h of ARDS diagnosis allows a more clinically relevant ARDS classification. METHODS: We studied 452 ARDS patients enrolled prospectively in two independent, multicenter cohorts treated with protective mechanical ventilation. At the time of ARDS diagnosis, patients had a PaO(2)/FiO(2) ≤ 200. In the derivation cohort (n = 170), we measured PaO(2)/FiO(2) with two levels of positive end-expiratory pressure (PEEP) (≥5 and ≥10 cmH(2)O) and two levels of FiO(2) (≥0.5 and 1.0) at ARDS onset and 24 h later. Dependent upon PaO(2) response, patients were reclassified into three groups: mild (PaO(2)/FiO(2) > 200), moderate (PaO(2)/FiO(2) 101-200), and severe (PaO(2)/FiO(2) ≤ 100) ARDS. The primary outcome measure was ICU mortality. The standard ventilatory setting that reached the highest significance difference in mortality among these categories was tested in a separate cohort (n = 282). RESULTS: The only standard ventilatory setting that identified the three PaO(2)/FiO(2) risk categories in the derivation cohort was PEEP ≥ 10 cmH(2)O and FiO(2) ≥ 0.5 at 24 h after ARDS onset (p = 0.0001). Using this ventilatory setting, patients in the validation cohort were reclassified as having mild ARDS (n = 47, mortality 17 %), moderate ARDS (n = 149, mortality 40.9 %), and severe ARDS (n = 86, mortality 58.1 %) (p = 0.00001). CONCLUSIONS: Our method for assessing PaO(2)/FiO(2) greatly improved risk stratification of ARDS and could be used for enrolling appropriate ARDS patients into therapeutic clinical trials. |
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Authors:
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Jesús Villar; Lina Pérez-Méndez; Jesús Blanco; José Manuel Añón; Lluís Blanch; Javier Belda; Antonio Santos-Bouza; Rosa Lidia Fernández; Robert M Kacmarek; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2013-1-31 |
Journal Detail:
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Title: Intensive care medicine Volume: - ISSN: 1432-1238 ISO Abbreviation: Intensive Care Med Publication Date: 2013 Jan |
Date Detail:
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Created Date: 2013-2-1 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7704851 Medline TA: Intensive Care Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain, jesus.villar54@gmail.com. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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