Rapidly improving ARDS differs clinically and biologically from persistent ARDS.

Autor: Valda Toro PL; Department of Medicine, Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, PA, USA. Patricia.valdatoro@pennmedicine.upenn.edu.; Department of Internal Medicine, University of California San Francisco, San Francisco, USA. Patricia.valdatoro@pennmedicine.upenn.edu., Willmore A; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Wu NE; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Delucchi KL; Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA., Jauregui A; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Sinha P; Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA., Liu KD; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA., Hendrickson CM; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA., Sarma A; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Neyton LPA; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Leligdowicz A; Department of Critical Care Medicine, Toronto Western Hospital, Toronto, Canada., Langelier CR; Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.; Chan Zuckerberg Biohub, San Francisco, CA, USA., Zhuo H; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Jones C; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Kangelaris KN; Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Gomez AD; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA., Matthay MA; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA., Calfee CS; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.; Department of Anesthesia, University of California, San Francisco, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Apr 22; Vol. 28 (1), pp. 132. Date of Electronic Publication: 2024 Apr 22.
DOI: 10.1186/s13054-024-04883-6
Abstrakt: Background: Rapidly improving acute respiratory distress syndrome (RIARDS) is an increasingly appreciated subgroup of ARDS in which hypoxemia improves within 24 h after initiation of mechanical ventilation. Detailed clinical and biological features of RIARDS have not been clearly defined, and it is unknown whether RIARDS is associated with the hypoinflammatory or hyperinflammatory phenotype of ARDS. The purpose of this study was to define the clinical and biological features of RIARDS and its association with inflammatory subphenotypes.
Methods: We analyzed data from 215 patients who met Berlin criteria for ARDS (endotracheally intubated) and were enrolled in a prospective observational cohort conducted at two sites, one tertiary care center and one urban safety net hospital. RIARDS was defined according to previous studies as improvement of hypoxemia defined as (i) PaO 2 :FiO 2  > 300 or (ii) SpO2: FiO 2  > 315 on the day following diagnosis of ARDS (day 2) or (iii) unassisted breathing by day 2 and for the next 48 h (defined as absence of endotracheal intubation on day 2 through day 4). Plasma biomarkers were measured on samples collected on the day of study enrollment, and ARDS phenotypes were allocated as previously described.
Results: RIARDS accounted for 21% of all ARDS participants. Patients with RIARDS had better clinical outcomes compared to those with persistent ARDS, with lower hospital mortality (13% vs. 57%; p value < 0.001) and more ICU-free days (median 24 vs. 0; p value < 0.001). Plasma levels of interleukin-6, interleukin-8, and plasminogen activator inhibitor-1 were significantly lower among patients with RIARDS. The hypoinflammatory phenotype of ARDS was more common among patients with RIARDS (78% vs. 51% in persistent ARDS; p value = 0.001).
Conclusions: This study identifies a high prevalence of RIARDS in a multicenter observational cohort and confirms the more benign clinical course of these patients. We report the novel finding that RIARDS is characterized by lower concentrations of plasma biomarkers of inflammation compared to persistent ARDS, and that hypoinflammatory ARDS is more prevalent among patients with RIARDS. Identification and exclusion of RIARDS could potentially improve prognostic and predictive enrichment in clinical trials.
(© 2024. The Author(s).)
Databáze: MEDLINE
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