Anesi George L, Ramkillawan Arisha, Invernizzi Jonathan, Savarimuthu Stella M, Wise Robert D, Farina Zane, Smith Michelle T D
Division of Pulmonary, Allergy, and Critical Care (G. L. A.), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; the Division of Pulmonary and Critical Care Medicine (S. M. S.), University of Rochester Medical Center, Rochester, NY; the Department of Anaesthesia and Critical Care (A. R., Z. F., and M. T. D. S.), Greys Hospital, KwaZulu-Natal Department of Health, the Department of Anaesthesia and Critical Care (J. I.), Harry Gwala Regional Hospital, KwaZulu-Natal Department of Health, Pietermaritzburg, the Department of Anaesthesia and Critical Care (R. D. W. and M. T. D. S.), School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa; the Faculty Medicine and Pharmacy (R. D. W.), Vrije Universiteit Brussel (VUB), Brussels, Belgium; and the Department of Intensive Care (R. D. W.), John Radcliffe Hospital, Oxford University Trust Hospitals, Oxford, England.
CHEST Crit Care. 2024 Dec;2(4). doi: 10.1016/j.chstcc.2024.100103. Epub 2024 Oct 28.
A proposed new global definition of ARDS seeks to update the Berlin definition and account for nonintubated ARDS and ARDS diagnoses in resource-variable settings.
How do ARDS epidemiologic characteristics change with operationalizing the new global definition of ARDS in a resource-limited setting?
We performed a real-use retrospective cohort study among adult patients meeting criteria for the Berlin definition of ARDS or the global definition of ARDS at ICU admission in two public hospitals in the KwaZulu-Natal Department of Health, South Africa, from January 2017 through June 2022.
Among 5,760 adults (aged ≥ 18 years) admitted to the ICU, 2,027 patients (35.2%) met at least one ARDS definition, including 1,218 patients meeting the Berlin definition of ARDS (60.1% of all ARDS diagnoses) and 809 new diagnoses of the global definition of ARDS that were not captured by the Berlin definition alone (39.9% of all ARDS diagnoses and 14.0% of all ICU admissions). After adjustment for hospital-level factors, patients who met only the global definition of ARDS criteria (ie, who would not have been captured by the Berlin definition) showed no statistically significant ICU mortality difference vs patients with ARDS according to the Berlin definition (21.7% [95% CI, 18.9%-24.4%] vs 23.8% [95% CI, 21.5%-26.2%]; OR, 0.88 [95% CI, 0.70-1.10]; = .25). In prespecified exploratory subgroup analyses, patients without COVID-19 who met only the criteria for the global definition of ARDS showed reduced ICU mortality (14.2% [95% CI, 11.6%-16.9%] vs 22.2% [95% CI, 19.8%-24.6%]; OR, 0.58 [95% CI, 0.45-0.75]; < .0005) compared with patients without COVID-19 who met the Berlin definition for ARDS.
The new global definition of ARDS captures a significant proportion of patients who would not have been included by the Berlin definition alone. These additional patients with ARDS may have heterogenous patterns of outcomes among diagnostic subgroups, including by COVID-19 status, compared with patients with ARDS according to the Berlin definition.
拟议的急性呼吸窘迫综合征（ARDS）全球新定义旨在更新柏林定义，并考虑资源条件各异环境中的非插管型ARDS及ARDS诊断情况。
在资源有限的环境中实施ARDS全球新定义后，ARDS的流行病学特征如何变化？
我们对2017年1月至2022年6月期间在南非夸祖鲁-纳塔尔省卫生部的两家公立医院重症监护病房（ICU）入院时符合柏林ARDS定义标准或ARDS全球定义标准的成年患者进行了一项实际应用回顾性队列研究。
在5760名入住ICU的成年人（年龄≥18岁）中，2027名患者（35.2%）符合至少一项ARDS定义，其中1218名患者符合柏林ARDS定义（占所有ARDS诊断的60.1%），另有809例新诊断的ARDS全球定义病例未被柏林定义单独涵盖（占所有ARDS诊断的39.9%，占所有ICU入院患者的14.0%）。在对医院层面因素进行调整后，仅符合ARDS全球定义标准的患者（即未被柏林定义涵盖的患者）与符合柏林定义的ARDS患者相比，ICU死亡率无统计学显著差异（21.7% [95%置信区间，18.9%-24.4%] 对比23.8% [95%置信区间，21.5%-26.2%]；比值比，0.88 [95%置信区间，0.70-1.10]；P = 0.25）。在预先设定的探索性子组分析中，未感染新冠病毒且仅符合ARDS全球定义标准的患者与未感染新冠病毒且符合柏林ARDS定义的患者相比，ICU死亡率降低（14.2% [95%置信区间，11.6%-16.9%] 对比22.2% [95%置信区间，19.8%-24.6%]；比值比，0.58 [95%置信区间，0.45-0.75]；P < 0.0005）。
ARDS全球新定义涵盖了很大一部分仅靠柏林定义无法纳入的患者。与符合柏林定义的ARDS患者相比，这些新增的ARDS患者在不同诊断亚组中的预后模式可能存在差异，包括按新冠病毒感染状况划分的亚组。
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