Top

BMC Medicine

Published in:

Open Access 01-12-2023 | Acute Respiratory Distress-Syndrome | Research article

The impact of the new acute respiratory distress syndrome (ARDS) criteria on Berlin criteria ARDS patients: a multicenter cohort study

Authors: Lina Zhao, Fuhong Su, Nannan Zhang, Hening Wu, Yuehao Shen, Haiying Liu, Xuguang Li, Yun Li, Keliang Xie

Published in: BMC Medicine | Issue 1/2023

Abstract

Objective

The European Society of Intensive Care Medicine (ESICM) recently recommended changes to the criteria of acute respiratory distress syndrome (ARDS), patients with high-flow oxygen were included, however, the effect of these changes remains unclear. Our objectives were to evaluate the performance of these new criteria and to compare the outcomes of patients meeting the new ARDS criteria with those meeting the Berlin ARDS criteria.

Methods

This was a retrospective cohort. The patients admitted to the intensive care unit (ICU) were diagnosed with ARDS. Patients were classified as meeting Berlin criteria ARDS (n = 4279), high-flow nasal oxygen (HFNO) criteria ARDS (n = 559), or new criteria ARDS (n = 4838).

Results

In comparison with HFNO criteria ARDS and new criteria ARDS, patients with Berlin criteria ARDS demonstrated lower blood oxygen levels assessed by PaO₂/FiO₂, SpO₂/FiO₂, and ROX (SpO₂/FiO₂/respiratory rate) (p < 0.001); and higher severity of illness assessed by the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology And Chronic Health Evaluations (APACHE II), Simplified Acute Physiology Score (SAPS II) (p < 0.001), (p < 0.001), and longer ICU and hospital stays (p < 0.001). In comparison with the HFNO criteria, patients meeting Berlin criteria ARDS had higher hospital mortality (10.6% vs. 16.9%; p = 0.0082), 28-day mortality (10.6% vs. 16.5%; p = 0.0079), and 90-day mortality (10.7% vs. 17.1%; p = 0.0083). ARDS patients with HFNO did not have severe ARDS; Berlin criteria ARDS patients with severe ARDS had the highest mortality rate (approximately 33%). PaO₂/FiO₂, SpO₂/FiO₂, and ROX negatively correlated with the SOFA and APACHE II scores. The SOFA and APACHE II scores had high specificity and sensitivity for prognosis in patients with new criteria ARDS.

Conclusion

The new criteria of ARDS reduced the severity of illness, length of stay in the ICU, length of hospital stays, and overall mortality. SOFA and APACHE II scores remain important in assessing the prognosis of patients with new criteria ARDS.

Trial registration

Registration number: ChiCTR2200067084.

Available only for authorised users

Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967;2(7511):319–23.CrossRefPubMed

Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573–82.CrossRefPubMed

ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526–33.

Ospina-Tascón GA, Calderón-Tapia LE, García AF, Zarama V, Gómez-Alvarez Freddy, Alvarez-Saa T, Pardo-Otálvaro S, Bautista-Rincón DF, Vargas MP, Aldana-Díaz JL. Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19: A Randomized Clinical Trial. JAMA. 2021; 326(21):2161–2171.

Perkins GD, JC, Connolly BA, Couper K, Lall R, Baillie JK, Bradley JM, Dark P, Dave C, De Soyza A, Dennis AV, Devrell A, Fairbairn S, Ghani H, Gorman EA, Green CA, Hart N, Hee SW, Kimbley Z, Madathil S, McGowan N, Messer B, Naisbitt J, Norman C, Parekh D, Parkin EM, Patel J, Regan SE, Ross C, Rostron AJ, Saim M, Simonds AK, Skilton E, Stallard N, Steiner M, Vancheeswaran R, Yeung J, McAuley DF; RECOVERY-RS Collaborators. Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial. JAMA. 2022; 327(6):546–558.

Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020;383(2):120–8.CrossRefPubMedPubMedCentral

Giacomo G, CSC, LC, Daniele P, MBPA, Massimo A, YMA, Baroncelli F, Beitler JR, Bellani G, Bellingan G, BB, Bos LDJ, Brochard L, Brodie D, Burns KEA, AC, D’Arrigo S, DDB, Demoule A, Einav S, EF, Ferguson ND, Frat J‑P, Gattinoni L, Guérin C, Herridge MS, Hodgson C, Hough CL, Jaber S, Jufermans Nicole P, CK, Kesecioglu J, Kwizera A, Lafey JG, Mancebo J, MAM, McAuley DF, Mercat A, Meyer NJ, Moss M, et al. ESICM guidelines on acute respiratory distress syndrome: defnition, phenotyping and respiratory support strategies. Intensive Care Med. 2023; 49(7):727–759.

Johnson AEW, Bulgarelli L, Shen L, Gayles A, Shammout A, Horng S, et al. MIMIC-IV, a freely accessible electronic health record dataset. Sci Data. 2023;10(1):1.

Pollard TJ, Johnson AEW, Raffa JD, Celi LAG, Badawi O. The eICU Collaborative Research Database, a freely available multi-center database for critical care research. Sci Data. 2018;5: 180178.CrossRefPubMedPubMedCentral

10.

Ferguson ND, Fan E, Camporota L, Antonelli M, Anzueto A, Beale R, et al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012;38(10):1573–82.

11.

Guerin C, Papazian L, Reignier J, Ayzac L, Loundou A, Forel JM. investigators of the A, Proseva t: Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care. 2016;20(1):384.CrossRefPubMedPubMedCentral

12.

Mi MY, Matthay MA, Morris AH. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2018;379(9):884–887.

13.

Ricard JD, Roca O, Lemiale V, Corley A, Braunlich J, Jones P, Kang BJ, Lellouche F, Nava S, Rittayamai N, et al. Use of nasal high flow oxygen during acute respiratory failure. Intensive Care Med. 2020;46(12):2238–47.CrossRefPubMedPubMedCentral

14.

Leasa D, Cameron P, Honarmand K, Mele T, Bosma KJ. Group LVSfC-W: Knowledge translation tools to guide care of non-intubated patients with acute respiratory illness during the COVID-19 Pandemic. Crit Care. 2021;25(1):22.CrossRefPubMedPubMedCentral

15.

Brown SM, Grissom CK, Moss M, Rice TW, Brower RG. Non-linear imputation of PaO2/FIO2 from SpO2/FIO2 among patients with Acute Respiratory Distress Syndrome. Chest. 2016;150(2):307–13.CrossRefPubMedPubMedCentral

16.

Brown SM, Duggal A, Hou PC, Tidswell M, Brower RG. Nonlinear Imputation of PaO2/FIO2 From SpO2/FIO2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study. Crit Care Med. 2017;45(8):1317–24.CrossRefPubMedPubMedCentral

17.

Raith EP, Udy AA, Bailey M, Mcgloughlin S, Macisaac C, Bellomo R, Pilcher DV. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA. 2017;317(3):290–300.CrossRefPubMed

18.

Soo A, Zuege DJ, Fick GH, Niven DJ, Berthiaume LR, Stelfox HT, Doig CJ. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care. 2019;23(1):186.CrossRefPubMedPubMedCentral

19.

Suistomaa M, Kari A, Ruokonen E, Takala J. Sampling rate causes bias in APACHE II and SAPS II scores. Intensive Care Med. 2000;26(12):1773–8.CrossRefPubMed

20.

Poncet A, Perneger TV, Merlani P, Capuzzo M, Combescure C. Determinants of the calibration of SAPS II and SAPS 3 mortality scores in intensive care: a European multicenter study. Crit Care. 2017;21(1):85.CrossRefPubMedPubMedCentral

21.

Moussa MD, Santonocito C, Fagnoul D, Donadello K, Pradier O, Gaussem P, De Backer D, Vincent JL. Evaluation of endothelial damage in sepsis-related ARDS using circulating endothelial cells. Intensive Care Med. 2015;41(2):231–8.CrossRefPubMed

22.

Yu ZX, Ji MS, Yan J, Cai Y, Liu J, Yang HF, Li Y, Jin ZC, Zheng JX. The ratio of Th17/Treg cells as a risk indicator in early acute respiratory distress syndrome. Crit Care. 2015;19(1):1–11.CrossRef

23.

Schmidt M, Hajage D, Demoule A, Pham T, Noublanche J. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60–73.

24.

Sinha P, Calfee CS, Cherian S, Brealey D, Szakmany T. Prevalence of phenotypes of acute respiratory distress syndrome in critically ill patients with COVID-19: a prospective observational study. Lancet Respir Med. 2020;8(12):1209–18.CrossRefPubMedPubMedCentral

Title: The impact of the new acute respiratory distress syndrome (ARDS) criteria on Berlin criteria ARDS patients: a multicenter cohort study
Authors: Lina Zhao
Fuhong Su
Nannan Zhang
Hening Wu
Yuehao Shen
Haiying Liu
Xuguang Li
Yun Li
Keliang Xie
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Acute Respiratory Distress-Syndrome
Published in: BMC Medicine / Issue 1/2023
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-023-03144-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The impact of the new acute respiratory distress syndrome (ARDS) criteria on Berlin criteria ARDS patients: a multicenter cohort study

Abstract

Objective

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2023

Body mass index and cancer risk among adults with and without cardiometabolic diseases: evidence from the EPIC and UK Biobank prospective cohort studies

Racial differences in healthcare expenditures for prevalent multimorbidity combinations in the USA: a cross-sectional study

Retraction Note: Therapeutic effect of nanoliposomal PCSK9 vaccine in a mouse model of atherosclerosis

Neutrophil activation may trigger tau burden contributing to cognitive progression of chronic sleep disturbance in elderly individuals not living with dementia

The economic burden of RSV-associated illness in children aged < 5 years, South Africa 2011–2016

Influence of poor sleep on cardiovascular disease-free life expectancy: a multi-resource-based population cohort study