TY - JOUR
T1 - Risk stratification using SpO2/FiO2 and PEEP at initial ARDS diagnosis and after 24 h in patients with moderate or severe ARDS
AU - for the MARS consortium
AU - Pisani, Luigi
AU - Roozeman, Jan Paul
AU - Simonis, Fabienne D.
AU - Giangregorio, Antonio
AU - van der Hoeven, Sophia M.
AU - Schouten, Laura R.
AU - Horn, Janneke
AU - Neto, Ary Serpa
AU - Festic, Emir
AU - Dondorp, Arjen M.
AU - Grasso, Salvatore
AU - Bos, Lieuwe D.
AU - Schultz, Marcus J.
AU - van Hooijdonk, Roosmarijn T.M.
AU - Huson, Mischa A.
AU - Straat, Marleen
AU - van Vught, Lonneke A.
AU - Wiewel, Maryse A.
AU - Witteveen, Esther
AU - Glas, Gerie J.
AU - Wieske, Luuk
AU - Frencken, Jos F.
AU - Bonten, Marc
AU - Klein Klouwenberg, Peter M.C.
AU - Ong, David
AU - Scicluna, Brendon P.
AU - Hoogendijk, Arjan J.
AU - Belkasim-Bohoudi, H.
AU - van der Poll, Tom
N1 - Publisher Copyright:
© 2017, The Author(s).
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: We assessed the potential of risk stratification of ARDS patients using SpO2/FiO2 and positive end-expiratory pressure (PEEP) at ARDS onset and after 24 h. Methods: We used data from a prospective observational study in patients admitted to a mixed medical–surgical intensive care unit of a university hospital in the Netherlands. Risk stratification was by cutoffs for SpO2/FiO2 and PEEP. The primary outcome was in-hospital mortality. Patients with moderate or severe ARDS with a length of stay of > 24 h were included in this study. Patients were assigned to four predefined risk groups: group I (SpO2/FiO2 ≥ 190 and PEEP < 10 cm H2O), group II (SpO2/FiO2 ≥ 190 and PEEP ≥ 10 cm), group III (SpO2/FiO2 < 190 and PEEP < 10 cm H2O) and group IV (SpO2/FiO2 < 190 and PEEP ≥ 10 cm H2O). Results: The analysis included 456 patients. SpO2/FiO2 and PaO2/FiO2 had a strong relationship (P < 0.001, R2 = 0.676) that could be described in a linear regression equation (SpO2/FiO2 = 42.6 + 1.0 * PaO2/FiO2). Risk stratification at initial ARDS diagnosis resulted in groups that had no differences in in-hospital mortality. Risk stratification at 24 h resulted in groups with increasing mortality rates. The association between group assignment at 24 h and outcome was confounded by several factors, including APACHE IV scores, arterial pH and plasma lactate levels, and vasopressor therapy. Conclusions: In this cohort of patients with moderate or severe ARDS, SpO2/FiO2 and PaO2/FiO2 have a strong linear relationship. In contrast to risk stratification at initial ARDS diagnosis, risk stratification using SpO2/FiO2 and PEEP after 24 h resulted in groups with worsening outcomes. Risk stratification using SpO2/FiO2 and PEEP could be practical, especially in resource-limited settings.
AB - Background: We assessed the potential of risk stratification of ARDS patients using SpO2/FiO2 and positive end-expiratory pressure (PEEP) at ARDS onset and after 24 h. Methods: We used data from a prospective observational study in patients admitted to a mixed medical–surgical intensive care unit of a university hospital in the Netherlands. Risk stratification was by cutoffs for SpO2/FiO2 and PEEP. The primary outcome was in-hospital mortality. Patients with moderate or severe ARDS with a length of stay of > 24 h were included in this study. Patients were assigned to four predefined risk groups: group I (SpO2/FiO2 ≥ 190 and PEEP < 10 cm H2O), group II (SpO2/FiO2 ≥ 190 and PEEP ≥ 10 cm), group III (SpO2/FiO2 < 190 and PEEP < 10 cm H2O) and group IV (SpO2/FiO2 < 190 and PEEP ≥ 10 cm H2O). Results: The analysis included 456 patients. SpO2/FiO2 and PaO2/FiO2 had a strong relationship (P < 0.001, R2 = 0.676) that could be described in a linear regression equation (SpO2/FiO2 = 42.6 + 1.0 * PaO2/FiO2). Risk stratification at initial ARDS diagnosis resulted in groups that had no differences in in-hospital mortality. Risk stratification at 24 h resulted in groups with increasing mortality rates. The association between group assignment at 24 h and outcome was confounded by several factors, including APACHE IV scores, arterial pH and plasma lactate levels, and vasopressor therapy. Conclusions: In this cohort of patients with moderate or severe ARDS, SpO2/FiO2 and PaO2/FiO2 have a strong linear relationship. In contrast to risk stratification at initial ARDS diagnosis, risk stratification using SpO2/FiO2 and PEEP after 24 h resulted in groups with worsening outcomes. Risk stratification using SpO2/FiO2 and PEEP could be practical, especially in resource-limited settings.
KW - Acute respiratory distress syndrome (ARDS)
KW - Blood gas analysis
KW - Classification
KW - Mortality
KW - Outcome
KW - Positive end-expiratory pressure (PEEP)
KW - Pulse oximetry
KW - Risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85032383207&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032383207&partnerID=8YFLogxK
U2 - 10.1186/s13613-017-0327-9
DO - 10.1186/s13613-017-0327-9
M3 - Article
AN - SCOPUS:85032383207
SN - 2110-5820
VL - 7
JO - Annals of Intensive Care
JF - Annals of Intensive Care
IS - 1
M1 - 108
ER -