Balzer Felix, Menk Mario, Ziegler Jannis, Pille Christian, Wernecke Klaus-Dieter, Spies Claudia, Schmidt Maren, Weber-Carstens Steffen, Deja Maria
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum / Campus Charité Mitte, Augustenburger Platz 1, D-13353, Berlin, Germany.
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
BMC Anesthesiol. 2016 Nov 8;16(1):108. doi: 10.1186/s12871-016-0272-4.
Currently there is no ARDS definition or classification system that allows optimal prediction of mortality in ARDS patients. This study aimed to examine the predictive values of the AECC and Berlin definitions, as well as clinical and respiratory parameters obtained at onset of ARDS and in the course of the first seven consecutive days.
The observational study was conducted at a 14-bed intensive care unit specialized on treatment of ARDS. Predictive validity of the AECC and Berlin definitions as well as PO/FO and FO/PO*P (oxygenation index) on mortality of ARDS patients was assessed and statistically compared.
Four hundred forty two critically-ill patients admitted for ARDS were analysed. Multivariate Cox regression indicated that the oxygenation index was the most accurate parameter for mortality prediction. The third day after ARDS criteria were met at our hospital was found to represent the best compromise between earliness and accuracy of prognosis of mortality regarding the time of assessment. An oxygenation index of 15 or greater was associated with higher mortality, longer length of stay in ICU and hospital and longer duration of mechanical ventilation. In addition, non-survivors had a significantly longer length of stay and duration of mechanical ventilation in referring hospitals before admitted to the national reference centre than survivors.
The oxygenation index is suggested to be the most suitable parameter to predict mortality in ARDS, preferably assessed on day 3 after admission to a specialized centre. Patients might benefit when transferred to specialized ICU centres as soon as possible for further treatment.
目前尚无急性呼吸窘迫综合征（ARDS）定义或分类系统能够对ARDS患者的死亡率进行最佳预测。本研究旨在检验美国欧洲共识会议（AECC）和柏林定义以及在ARDS发病时和连续七天病程中获得的临床和呼吸参数的预测价值。
该观察性研究在一家拥有14张床位、专门治疗ARDS的重症监护病房进行。评估并统计比较了AECC和柏林定义以及氧合指数（PO/FO和FO/PO*P）对ARDS患者死亡率的预测效度。
对442例因ARDS入院的重症患者进行了分析。多变量Cox回归表明，氧合指数是预测死亡率最准确的参数。发现我院达到ARDS标准后的第三天是评估死亡率预后的及时性和准确性之间的最佳平衡点。氧合指数为15或更高与更高的死亡率、更长的重症监护病房（ICU）和医院住院时间以及更长的机械通气时间相关。此外，非幸存者在转入国家参考中心之前，在转诊医院的住院时间和机械通气时间明显长于幸存者。
建议氧合指数是预测ARDS死亡率最合适的参数，最好在入住专科中心后第3天进行评估。患者尽快转入专科ICU中心接受进一步治疗可能会受益。
