新急性呼吸窘迫综合征（ARDS）标准对柏林 ARDS 标准患者的影响：一项多中心队列研究。
The impact of the new acute respiratory distress syndrome (ARDS) criteria on Berlin criteria ARDS patients: a multicenter cohort study.
机构信息
Department of Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, China.
Experimental Laboratory of Intensive Care, Université Libre de Bruxelles, 1000, Brussels, Belgium.
出版信息
BMC Med. 2023 Nov 23;21(1):456. doi: 10.1186/s12916-023-03144-7.
OBJECTIVE
The European Society of Intensive Care Medicine (ESICM) recently recommended changes to the criteria of acute respiratory distress syndrome (ARDS), patients with high-flow oxygen were included, however, the effect of these changes remains unclear. Our objectives were to evaluate the performance of these new criteria and to compare the outcomes of patients meeting the new ARDS criteria with those meeting the Berlin ARDS criteria.
METHODS
This was a retrospective cohort. The patients admitted to the intensive care unit (ICU) were diagnosed with ARDS. Patients were classified as meeting Berlin criteria ARDS (n = 4279), high-flow nasal oxygen (HFNO) criteria ARDS (n = 559), or new criteria ARDS (n = 4838).
RESULTS
In comparison with HFNO criteria ARDS and new criteria ARDS, patients with Berlin criteria ARDS demonstrated lower blood oxygen levels assessed by PaO/FiO, SpO/FiO, and ROX (SpO/FiO/respiratory rate) (p < 0.001); and higher severity of illness assessed by the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology And Chronic Health Evaluations (APACHE II), Simplified Acute Physiology Score (SAPS II) (p < 0.001), (p < 0.001), and longer ICU and hospital stays (p < 0.001). In comparison with the HFNO criteria, patients meeting Berlin criteria ARDS had higher hospital mortality (10.6% vs. 16.9%; p = 0.0082), 28-day mortality (10.6% vs. 16.5%; p = 0.0079), and 90-day mortality (10.7% vs. 17.1%; p = 0.0083). ARDS patients with HFNO did not have severe ARDS; Berlin criteria ARDS patients with severe ARDS had the highest mortality rate (approximately 33%). PaO/FiO, SpO/FiO, and ROX negatively correlated with the SOFA and APACHE II scores. The SOFA and APACHE II scores had high specificity and sensitivity for prognosis in patients with new criteria ARDS.
CONCLUSION
The new criteria of ARDS reduced the severity of illness, length of stay in the ICU, length of hospital stays, and overall mortality. SOFA and APACHE II scores remain important in assessing the prognosis of patients with new criteria ARDS.
TRIAL REGISTRATION
Registration number: ChiCTR2200067084.
目的
欧洲危重病医学会（ESICM）最近建议修改急性呼吸窘迫综合征（ARDS）的标准，将接受高流量氧疗的患者纳入其中，但这些变化的效果仍不清楚。我们的目的是评估这些新标准的性能，并比较符合新 ARDS 标准和柏林 ARDS 标准的患者的结局。
方法
这是一项回顾性队列研究。入组 ICU 诊断为 ARDS 的患者。患者分为符合柏林 ARDS 标准（n=4279）、高流量鼻氧（HFNO）标准 ARDS（n=559）或新 ARDS 标准（n=4838）。
结果
与 HFNO 标准 ARDS 和新 ARDS 标准相比，柏林 ARDS 标准 ARDS 患者的 PaO/FiO、SpO/FiO 和 ROX（SpO/FiO/呼吸频率）评估的血氧水平更低（p<0.001）；SOFA 评分、急性生理学和慢性健康评估（APACHE II）、简化急性生理学评分（SAPS II）评估的疾病严重程度更高（p<0.001），（p<0.001），以及 ICU 和住院时间更长（p<0.001）。与 HFNO 标准相比，符合柏林 ARDS 标准的患者的住院死亡率更高（10.6%比 16.9%；p=0.0082），28 天死亡率更高（10.6%比 16.5%；p=0.0079），90 天死亡率更高（10.7%比 17.1%；p=0.0083）。HFNO 标准 ARDS 患者没有严重 ARDS；柏林 ARDS 标准 ARDS 患者的严重 ARDS 死亡率最高（约 33%）。PaO/FiO、SpO/FiO 和 ROX 与 SOFA 和 APACHE II 评分呈负相关。SOFA 和 APACHE II 评分对新 ARDS 标准患者的预后具有较高的特异性和敏感性。
结论
新的 ARDS 标准降低了疾病严重程度、ICU 住院时间、住院时间和总体死亡率。SOFA 和 APACHE II 评分在评估新 ARDS 标准患者的预后方面仍然很重要。
试验注册
注册号：ChiCTR2200067084。
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