External confirmation and exploration of the Kigali modification for diagnosing moderate or severe ARDS

Vercesi, Veronica; Pisani, Luigi; Tongeren, Patricia S. I. van; Lagrand, Wim K.; Leopold, Stije J.; Huson, Mischa M. A.; Henwood, Patricia C.; Walden, Andrew; Smit, Marry R.; Riviello, Elisabeth D.; Pelosi, Paolo; Dondorp, Arjen M.; Schultz, Marcus J.

doi:10.1007/s00134-018-5048-5

Cited by 47 publications

(51 citation statements)

References 6 publications

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“…This allowed us to perform a comparative analysis using various definitions for ARDS. Another strength is the larger number of patients in our study compared with prior published work on lung ultrasound in ARDS [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

et al. 2018

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BackgroundLung ultrasound may be a reasonable alternative to chest radiography for the identification of acute respiratory distress syndrome (ARDS), but the diagnostic performance of lung ultrasound for ARDS is uncertain. We therefore analyzed the clinical outcomes of ARDS diagnosed according to the Berlin Definition, using either chest radiography (Berlin-CXR) or lung ultrasound (Berlin-LUS) as an alternative imaging method.MethodsThis was a retrospective observational study in a 20-bed medical intensive care unit (ICU). Patients who required noninvasive ventilation or invasive ventilation for hypoxemic respiratory failure on ICU admission from August 2014 to March 2017 were included. Both chest radiography and lung ultrasound were performed routinely upon ICU admission. Comparisons were made using either the Berlin-CXR or Berlin-LUS definitions to diagnose ARDS with respect to the patient characteristics and clinical outcomes for each definition. ICU and hospital mortality were the main outcome measures for both definitions.ResultsThe first admissions of 456 distinct patients were analyzed. Compared with the 216 patients who met the Berlin-CXR definition (ICU mortality 19.4%, hospital mortality 36.1%), 229 patients who met the Berlin-LUS definition (ICU mortality 22.7%, hospital mortality 34.5%) and 79 patients who met the Berlin-LUS but not the Berlin-CXR definition (ICU mortality 21.5%, hospital mortality 29.1%) had similar outcomes. In contrast, the 295 patients who met either definition had higher mortality than the 161 patients who did not meet either definition (ICU mortality 20.0% versus 12.4%, P = 0.041; hospital mortality 34.2% versus 24.2%, P = 0.027). Compared with Berlin-CXR, Berlin-LUS had a positive predictive value of 0.66 (95% confidence interval 0.59–0.72) and a negative predictive value of 0.71 (0.65–0.77). Among the 216 Berlin-CXR ARDS patients, 150 patients (69.4%) also fulfilled Berlin-LUS definition.ConclusionsFor the identification of ARDS using the Berlin definition, both chest radiography and lung ultrasound were equally related to mortality. The Berlin definition using lung ultrasound helped identify patients at higher risk of death, even if these patients did not fulfill the conventional Berlin definition using chest radiography. However, the moderate overlap of patients when chest imaging modalities differed suggests that chest radiography and lung ultrasound should be complementary rather than used interchangeably.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2105-y) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Apart from a small pilot study [ 11 ] and a recent evaluation of the Kigali Modification [ 12 ], the use of chest radiography versus the use of lung ultrasound for the identification of ARDS has not been systematically studied. It is also unclear how the choice of imaging would affect ARDS identification.…”

Section: Introductionmentioning

confidence: 99%

Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

et al. 2018

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“…The Kigali modification of the Berlin definitions of ARDS uses pulse oximetry and LUS findings to define the severity of ARDS, and has proven to be an excellent alternative to the Berlin definition, which relies on blood gas analysis and chest X-ray or CT scan findings. 22,23 Supplemental oxygen. In patients with moderate severe COVID-19, supplemental oxygen can be provided using simple nose prongs or face masks with an oxygen flow up to around 5-6 L O 2 /minute.…”

Section: Introductionmentioning

confidence: 99%

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Dondorp

Hayat

Aryal³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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163

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The ongoing novel coronavirus disease pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning.The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive endexpiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients.

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“…8 Scores are then summed to a global score that ranges from 0 (i.e., "no abnormalities at all") to 36 (i.e., "consolidations in all regions"). Global LUS scores combined with SpO 2 /FiO 2 in a resourcelimited setting, 9 and with PaO 2 /FiO 2 in a resource-rich setting, 10 showed good performance for diagnosing acute respiratory distress syndrome (ARDS) and for assessing ARDS severity. 11 Of note, current global LUS scores do not include pleural thickening and subpleural abnormalities, which seem often present in COVID-19.…”

mentioning

confidence: 99%

Challenges and Opportunities for Lung Ultrasound in Novel Coronavirus Disease (COVID-19)

Schultz

Sivakorn

Dondorp

2020

The American Journal of Tropical Medicine and Hygiene

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External confirmation and exploration of the Kigali modification for diagnosing moderate or severe ARDS

Cited by 47 publications

References 6 publications

Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

Chest radiography versus lung ultrasound for identification of acute respiratory distress syndrome: a retrospective observational study

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Challenges and Opportunities for Lung Ultrasound in Novel Coronavirus Disease (COVID-19)

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