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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2019

01-04-2019 | Understanding the Disease

Acute respiratory distress syndrome (ARDS) phenotyping

Authors: M. Shankar-Hari, E. Fan, N. D. Ferguson

Published in: Intensive Care Medicine | Issue 4/2019

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Excerpt

Clinically, the Berlin ARDS definition describes acute respiratory distress syndrome (ARDS) as acute hypoxaemic respiratory failure that is not fully explained by cardiac failure or fluid overload, that develops within 7 days of clinical recognition of a known risk factor, with bilateral radiographic opacities that are not fully explained by effusions, lobar/lung collapse, or nodules. Three risk strata were defined on the basis of the severity of hypoxaemia represented by the ratio of partial pressure of oxygen in arterial blood to inspired oxygen concentration (PaO2/FiO2 ratio), assessed at a minimum positive end-expiratory pressure (PEEP) of 5 cmH2O [1]. Hospital mortality worsens with severity of hypoxaemia and thus grade of ARDS (from 35% in mild ARDS to 46% in severe ARDS) [1, 2]. …
Literature
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ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307:2526–2533
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Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson BT, Wrigge H, Slutsky AS, Pesenti A, LUNG SAFE Investigators, ESICM Trials Group (2016) Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 315:788–800CrossRefPubMed
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Thompson BT, Chambers RC, Liu KD (2017) Acute respiratory distress syndrome. N Engl J Med 377:562–572CrossRefPubMed
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Famous KR, Delucchi K, Ware LB, Kangelaris KN, Liu KD, Thompson BT, Calfee CS, ARDS Network (2017) Acute respiratory distress syndrome subphenotypes respond differently to randomized fluid management strategy. Am J Respir Crit Care Med 195:331–338CrossRefPubMedPubMedCentral
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Calfee CS, Delucchi KL, Sinha P, Matthay MA, Hackett J, Shankar-Hari M, McDowell C, Laffey JG, O'Kane CM, McAuley DF, Irish Critical Care Trials Group (2018) Acute respiratory distress syndrome subphenotypes and differential response to simvastatin: secondary analysis of a randomised controlled trial. Lancet Respir Med 6:691–698CrossRefPubMed
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Delucchi K, Famous KR, Ware LB, Parsons PE, Thompson BT, Calfee CS, ARDS Network (2018) Stability of ARDS subphenotypes over time in two randomised controlled trials. Thorax 73:439–445CrossRefPubMedPubMedCentral
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Sinha P, Delucchi KL, Thompson BT, McAuley DF, Matthay MA, Calfee CS, NHLBI ARDS Network(2018) Latent class analysis of ARDS subphenotypes: a secondary analysis of the statins for acutely injured lungs from sepsis (SAILS) study. Intensive Care Med 44:1859–1869CrossRefPubMed
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Bos LD, Schouten LR, van Vught LA, Wiewel MA, Ong DSY, Cremer O, Artigas A, Martin-Loeches I, Hoogendijk AJ, van der Poll T, Horn J, Juffermans N, Calfee CS, Schultz MJ, MARS Consortium (2017) Identification and validation of distinct biological phenotypes in patients with acute respiratory distress syndrome by cluster analysis. Thorax 72:876–883CrossRefPubMedPubMedCentral
Metadata
Title
Acute respiratory distress syndrome (ARDS) phenotyping
Authors
M. Shankar-Hari
E. Fan
N. D. Ferguson
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 4/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5480-6

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