Maitra Souvik, Baidya Dalim K, Ray Bikash R, Kayina Choro A, Haritha Damarla, Nair Parvathy R, Bhattacharjee Sulagna
Department of Anaesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Guwahati, Assam, India.
Indian J Crit Care Med. 2025 Jul;29(7):556-561. doi: 10.5005/jp-journals-10071-25006. Epub 2025 Jul 7.
A recent acute respiratory distress syndrome (ARDS) definition included patients receiving high-flow nasal oxygen (HFNO) when fulfilling the oxygenation and radiological criteria of ARDS Berlin definition. However, outcome of patients treated may be better than those who fulfilled the corresponding class of Berlin definition. This study was aimed to compare the survival between patients fulfilling Berlin definition and patients managed by HFNO initially.
Patients fulfilling the World Health Organization case definition of severe or critical COVID-19 infection requiring HFNO (at least 30 L/minute of flow), noninvasive ventilation (NIV) (at least a positive end-expiratory pressure (PEEP) of 5 cm HO), or invasive mechanical ventilation (at least a PEEP of 5 cm HO) were included in this study provided they fulfilled oxygenation and radiological criteria of ARDS as per Berlin definition.
All-cause hospital mortality rate in patients who fulfilled Berlin definition ( = 193) was 47.6% (mild ARDS), 64.9% (moderate ARDS), and 67.9% (severe ARDS) ( = 0.23). Multivariable survival analysis reported that hazard of death was higher in patients who fulfilled Berlin definition as opposed to those who were initially managed by HFNO (adjusted hazard ratio (95% confidence interval) 1.68 (1.15-2.45), = 0.007) after adjustment for age, Charlson comorbidity index, and baseline PaO/FiO ratio. Multiple pairwise comparison reported that hazard of death was lower in patients with moderate ARDS requiring HFNO as compared with the moderate ARDS patients as per Berlin definition ( = 0.024). However, no difference was observed in patients of mild ( = 0.39) and severe ARDS ( = 0.24).
We have found a statistically significant higher survival in ARDS patients managed by HFNO in the first 24 hours after intensive care unit (ICU) admission when compared with the patients receiving NIV or invasive mechanical ventilation. So, we conclude that outcome of patients fulfilling the global definition of ARDS is largely different from those who fulfilled Berlin definition. Hence, prospective multicentric validation is required before its bedside use.
Maitra S, Baidya DK, Ray BR, Kayina CA, Haritha D, Nair PR, . Validation of Global Definition of Acute Respiratory Distress Syndrome in COVID-19 Patients: A Retrospective Study. Indian J Crit Care Med 2025;29(7):556-561.
近期急性呼吸窘迫综合征（ARDS）的定义纳入了符合ARDS柏林定义的氧合和影像学标准且接受高流量鼻导管给氧（HFNO）的患者。然而，接受治疗的患者的预后可能优于符合柏林定义相应级别的患者。本研究旨在比较符合柏林定义的患者与最初接受HFNO治疗的患者之间的生存率。
符合世界卫生组织严重或危重型新型冠状病毒肺炎感染病例定义且需要HFNO（至少30升/分钟流量）、无创通气（NIV）（至少呼气末正压（PEEP）为5厘米水柱）或有创机械通气（至少PEEP为5厘米水柱）的患者纳入本研究，前提是他们符合ARDS柏林定义的氧合和影像学标准。
符合柏林定义的患者（n = 193）的全因住院死亡率为47.6%（轻度ARDS）、64.9%（中度ARDS）和67.9%（重度ARDS）（P = 0.23）。多变量生存分析表明，在对年龄、查尔森合并症指数和基线PaO₂/FiO₂比值进行调整后，符合柏林定义的患者的死亡风险高于最初接受HFNO治疗的患者（调整后的风险比（95%置信区间）为1.68（1.15 - 2.45），P = 0.007）。多重两两比较表明，与符合柏林定义的中度ARDS患者相比，需要HFNO的中度ARDS患者的死亡风险更低（P = 0.024）。然而，轻度（P = 0.39）和重度ARDS患者之间未观察到差异。
我们发现，与接受NIV或有创机械通气的患者相比，在重症监护病房（ICU）入院后最初24小时内接受HFNO治疗的ARDS患者的生存率在统计学上显著更高。因此，我们得出结论，符合ARDS全球定义的患者的预后与符合柏林定义的患者有很大不同。因此，在床边使用之前需要进行前瞻性多中心验证。
Maitra S, Baidya DK, Ray BR, Kayina CA, Haritha D, Nair PR, 等。新型冠状病毒肺炎患者急性呼吸窘迫综合征全球定义的验证：一项回顾性研究。《印度重症监护医学杂志》2025；29(7):556 - 561。
