Abstract
BackgroundIn the Berlin definition, acute respiratory distress syndrome (ARDS) is stratified into three stages according to oxygenation severity at the onset. The relevance between ARDS severity and prognosis varies among published reports and has not been verified, especially in Asian patients.MethodsIn this study, we examined the associations between the Berlin definition criteria and prognosis and clinical parameters, including high-resolution computed tomography (HRCT) scores of fibroproliferative changes of the lungs. One hundred fifty-three patients (45 females; mean age, 67 y/o), who met the Berlin definition and received treatment in our intensive care unit between January 2012 and December 2015, were enrolled.ResultsThe severity of ARDS was mild in 42 patients, moderate in 71, and severe in 40. The underlying diseases included pneumonia in 56 patients and aspiration in 43. Forty-two (27.5%) patients were deceased within 30 days, and the 30-day mortality was 10% in mild ARDS, 23% in moderate, and 55% in severe, which were significantly different (P < 0.05). In the non-survivors, APACHE II, SOFA, and SAPS II scores were higher than in the survivors (P < 0.001). Multivariate analyses revealed that elevated blood lactate level (≥ 2.0 mmol/L) and increased HRCT scores were significantly associated with weaning failure and 30-day mortality of the patients with ARDS.ConclusionsThese results suggested that the severity criteria in the Berlin definition might be associated with the prognosis of the patients. Blood lactate levels and HRCT score might be predictive of the outcome of patients with ARDS.
Highlights
Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury, characterized by increases in pulmonary vascular permeability and extravascular lung water and loss of aerated lung areas [1]
We evaluated whether the severity criteria by the Berlin definition was associated with the outcome in consecutive patients with acute respiratory distress syndrome (ARDS) in an intensive care units (ICUs) of a university hospital
Severity of ARDS The severity of ARDS was stratified in accordance with the Berlin definition criteria
Summary
Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury, characterized by increases in pulmonary vascular permeability and extravascular lung water and loss of aerated lung areas [1]. The Berlin definition of the 2012 announcement defines the severity of ARDS in the oxygenation index [1]. The new PaO2/FIO2 thresholds chosen for different levels of ARDS severity. The relevance between ARDS severity and prognosis is variable among published reports and has not. Maiolo and colleagues reported that using the 150-mm-Hg PaO2/FIO2 threshold gave a more homogeneous distribution of patients with ARDS across the severity subgroups and identified two populations that differed in their anatomical and physiological characteristics [5]. In the Berlin definition, acute respiratory distress syndrome (ARDS) is stratified into three stages according to oxygenation severity at the onset. The relevance between ARDS severity and prognosis varies among published reports and has not been verified, especially in Asian patients
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