Reclassifying Acute Respiratory Distress Syndrome

• DOI: 10.1164/rccm.201709-1804oc
• Publication Date: 2018-01-18T22:00:52Z
• Authors: Giorgia Maiolo; Francesca Collino; Francesco Vasques; Francesca Rapetti; Tommaso Tonetti; Federica Romitti; Massimo Cressoni; Davide Chiumello; Onnen Moerer; Peter Herrmann; Tim Friede; Michael Quintel; Luciano Gattinoni
• Keywords: Adult; Aged, 80 and over; Male; Respiratory Distress Syndrome; Acute respiratory distress syndrome; Computed tomographic analysis; Extracorporeal membrane oxygenation; Lung inhomogeneity; Mechanical ventilation; Middle Aged; Respiration, Artificial; acute respiratory distress syndrome; computed tomographic analysis; extracorporeal membrane oxygenation; lung inhomogeneity; mechanical ventilation; 3. Good health; 03 medical and health sciences; Dyspnea; Extracorporeal Membrane Oxygenation; 0302 clinical medicine; Italy; Germany; Humans; Female; Chile; Acute respiratory distress syndrome; Computed tomographic analysis; Extracorporeal membrane oxygenation; Lung inhomogeneity; Mechanical ventilation; Pulmonary and Respiratory Medicine; Critical Care and Intensive Care Medicine; Aged

The ratio of PaO2 to FiO2 (P/F) defines acute respiratory distress syndrome (ARDS) severity and suggests appropriate therapies.We investigated 1) whether a 150-mm-Hg P/F threshold within the range moderate ARDS (100-200 mm Hg) would define two subgroups that were more homogeneous; 2) which criteria led clinicians apply extracorporeal membrane oxygenation (ECMO) in severe ARDS.At threshold, patients split into mild-moderate (n = 50) moderate-severe 55) groups. Patients with (FiO2 not available three patients) higher 63) lower 18) groups at an 80% threshold.Compared ARDS, had peak pressures, PaCO2, pH. They also heavier lungs, greater inhomogeneity, noninflated tissue, lung recruitability. Within 84 (P/F < 100 Hg), 75% belonged subgroup. differed from only PaCO2 weight. Forty-one 46 treated ECMO group. this group, receiving than 22 non-ECMO patients. inhomogeneity ratio, total weight, tissue significantly higher.Using gave homogeneous distribution across identified populations their anatomical physiological characteristics. almost 90% them