An Early Test of Survival in Patients with the Adult Respiratory Distress Syndrome

Bone, Roger C.; Maunder, Richard J.; Slotman, Gus J.; Silverman, Henry; Hyers, Thomas M.; Kerstein, Morris D.; Ursprung, Joseph J.

doi:10.1378/chest.96.4.849

Cited by 146 publications

(26 citation statements)

References 10 publications

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“…Th ese fi ndings are concordant with several studies that have shown that the PF ratio measured at the onset of ARDS is not an independent predictor of mortality. [20][21][22][23][24][25] One possible explanation for the lack of the power of the PF ratio to discriminate adverse outcome in ARDS is that the PF ratio is highly variable depending on the ventilator strategy chosen. In one study, standardization of ventilator settings greatly improved risk stratifi cation of ARDS by PF ratio.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Cui

Janz

Shaver

et al. 2015

Chest

134

116

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Cui

Janz

Shaver

et al. 2015

Chest

134

116

View full text Add to dashboard Cite

show abstract

“…First, measures of lung injury will not perform well as prognostic measures because non-pulmonary factors including age, severity of sepsis, co-morbidities and non-pulmonary organ failure remain the most influential predictors of hospital mortality in ARDS, [25-39] and non-resolving respiratory failure accounts for less than 20% of ARDS deaths [34-36]. Also, although the finding that PaO 2 /FiO 2 level is associated with mortality is consistent with the findings reported from cohorts used for empirical analysis in the development of the Berlin ARDS definition, [40-46] this has not been demonstrated consistently, a finding that may be attributable, in part, to practice variability in mechanical ventilation settings, which is known to have a large effect on PaO 2 /FiO 2 levels [5,6,24,47,48].…”

Section: Discussionmentioning

confidence: 99%

Is there still a role for the lung injury score in the era of the Berlin definition ARDS?

et al. 2014

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BackgroundThe Lung Injury Score (LIS) remains a commonly utilized measure of lung injury severity though the additive value of LIS to predict ARDS outcomes over the recent Berlin definition of ARDS, which incorporates severity, is not known.MethodsWe tested the association of LIS (in which scores range from 0 to 4, with higher scores indicating more severe lung injury) and its four components calculated on the day of ARDS diagnosis with ARDS morbidity and mortality in a large, multi-ICU cohort of patients with Berlin-defined ARDS. Receiver Operator Characteristic (ROC) curves were generated to compare the predictive validity of LIS for mortality to Berlin stages of severity (mild, moderate and severe).ResultsIn 550 ARDS patients, a one-point increase in LIS was associated with 58% increased odds of in-hospital death (95% CI 14 to 219%, P = 0.006), a 7% reduction in ventilator-free days (95% CI 2 to 13%, P = 0.01), and, among patients surviving hospitalization, a 25% increase in days of mechanical ventilation (95% CI 9 to 43%, P = 0.001) and a 16% increase (95% CI 2 to 31%, P = 0.02) in the number of ICU days. However, the mean LIS was only 0.2 points higher (95% CI 0.1 to 0.3) among those who died compared to those who lived. Berlin stages of severity were highly correlated with LIS (Spearman’s rho 0.72, P < 0.0001) and were also significantly associated with ARDS mortality and similar morbidity measures. The predictive validity of LIS for mortality was similar to Berlin stages of severity with an area under the curve of 0.58 compared to 0.60, respectively (P-value 0.49).ConclusionsIn a large, multi-ICU cohort of patients with ARDS, both LIS and the Berlin definition severity stages were associated with increased in-hospital morbidity and mortality. However, predictive validity of both scores was marginal, and there was no additive value of LIS over Berlin. Although neither LIS nor the Berlin definition were designed to prognosticate outcomes, these findings suggest that the role of LIS in characterizing lung injury severity in the era of the Berlin definition ARDS may be limited.

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“…Oxygenation Index (OI) was calculated as the product of mean airway pressure and the percent of inspired oxygen divided by the partial pressure of arterial oxygen. 17 …”

Section: Methodsmentioning

confidence: 99%

The Association Between Physiologic Dead-Space Fraction and Mortality in Subjects With ARDS Enrolled in a Prospective Multi-Center Clinical Trial

et al. 2013

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Objective To test the association between pulmonary dead-space fraction (VD/VT) and mortality in patients with ARDS (Berlin Definition, PaO2/FiO2 ≤ 300 mm Hg; PEEP ≥ 5 cm H2O) enrolled into a clinical trial incorporating lung-protective ventilation. Design Prospective, multi-center study. Setting Medical-surgical intensive care units in the United States. Subjects 126 ALI patients enrolled into a phase III randomized, placebo-controlled study of aerosolized albuterol. Interventions None Measurements and Main Results VD/VT and pulmonary mechanics were measured within 4 hours of enrollment and repeated daily on study days 1 and 2 in subjects requiring arterial blood gases for clinical management. At baseline, non-survivors had a trend towards higher VD/VT compared to survivors (0.62 ± 0.11 vs. 0.56 ± 0.11 respectively, p = 0.08). Differences in VD/VT between non-survivors and survivors became significant on study days 1 (0.64 ± 0.12 vs. 0.55 ± 0.11 respectively, p = 0.01) and 2 (0.67 ± 0.12 vs. 0.56 ± 0.11 respectively, p=0.004). Likewise, the association between VD/VT and mortality was significant on study day 1 (odds ratio per 0.10 change in VD/VT [95% confidence interval]: 6.84 [1.62–28.84] p = 0.01; and study day 2: 4.90 [1.28–18.73] p = 0.02) after adjusting for VD/VT, PaO2/FiO2, oxygenation index, vasopressor use and the primary risk for ARDS. Using a Cox proportional hazard model, VD/VT was associated with a trend towards higher mortality (HR = 4.37 [CI: 0.99 – 19.32]; p = 0.052) that became significant when the analysis was adjusted for daily oxygenation index (HR = 1.74 [95% CI: 1.12 – 3.35] p = 0.04). Conclusions Markedly elevated VD/VT (≥ 0.60) in early ARDS is associated with higher mortality. Measuring VD/VT may be useful in identifying ARDS patients at increased risk of death who are enrolled into a therapeutic trial.

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An Early Test of Survival in Patients with the Adult Respiratory Distress Syndrome

Cited by 146 publications

References 10 publications

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Clinical Characteristics and Outcomes Are Similar in ARDS Diagnosed by Oxygen Saturation/F io 2 Ratio Compared With Pao 2 /F io 2 Ratio

Is there still a role for the lung injury score in the era of the Berlin definition ARDS?

The Association Between Physiologic Dead-Space Fraction and Mortality in Subjects With ARDS Enrolled in a Prospective Multi-Center Clinical Trial

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