Zespół ostrej niewydolności oddechowej – Rokowania, prognozy i postęp choroby

Zespół ostrej niewydolności oddechowej
Rokowania, prognozy i postęp choroby

Zespół ostrej niewydolności oddechowej (ARDS) charakteryzuje się ostrym początkiem obustronnych zmian w pęcherzykach płucnych oraz hipoksemią, z wysoką śmiertelnością sięgającą 25-40%, choć współczesne leczenie poprawia przeżywalność do 55-75%. Kluczowe parametry prognostyczne oceniane w pierwszych 1-2 dobach po intubacji to wskaźnik utlenowania (OI ≥15), pozanaczyniowa woda płucna (EVLWI), stosunek PaO₂/FiO₂, skale SOFA (≥10) i APACHE II, a także średnie ciśnienie tętnicze (MAP), które jest istotne dla przewidywania 60-dniowej śmiertelności. Modele prognostyczne, takie jak skala APPS oraz algorytmy uczenia maszynowego (np. Random Forest z AUC 0,84), wykazują wyższą dokładność w ocenie ryzyka i mogą wspierać decyzje terapeutyczne oraz rekrutację do badań klinicznych.

Prognostyka zespołu ostrej niewydolności oddechowej (ARDS)

Wskaźniki prognostyczne w ARDS
Optymalne parametry prognostyczne i czas ich oceny
Skale prognostyczne w ARDS
Predykcja czasu wentylacji mechanicznej
Czynniki wpływające na rokowanie
Zalecenia terapeutyczne wpływające na rokowanie
Ocena skuteczności leczenia
Odległa obserwacja i rokowanie u osób, które przeżyły ARDS
Kolejne rozdziały

Prognostyka zespołu ostrej niewydolności oddechowej (ARDS)

Zespół ostrej niewydolności oddechowej (ARDS – Acute Respiratory Distress Syndrome) to zagrażająca życiu forma niewydolności oddechowej charakteryzująca się ostrym początkiem obustronnych zmian w pęcherzykach płucnych oraz hipoksemią. Jest to poważny stan chorobowy z istotną śmiertelnością i chorobowością w oddziałach intensywnej terapii, a jego leczenie ma głównie charakter wspomagający.¹²

Szacuje się, że około milion pacjentów na całym świecie rozwija ARDS każdego roku, a ponad jedna trzecia z nich nie przeżyje tej choroby. Śmiertelność związana z ARDS waha się od 25% do 40%, przy czym w ostatnich latach obserwuje się pewną poprawę przeżywalności. Wskaźniki przeżycia przy odpowiednim leczeniu wynoszą obecnie około 55-75%.³⁴⁵

Wskaźniki prognostyczne w ARDS

Wczesne rozpoznanie pacjentów wysokiego ryzyka z ARDS może poprawić ich rokowanie poprzez szybsze wdrożenie intensywnej terapii, w tym potencjalnie pozaustrojowego natleniania krwi (ECMO). Badania wykazały, że nasilenie uszkodzenia płuc oceniane w ciągu 24 godzin od początku ARDS jest głównym czynnikiem determinującym rokowanie.⁶⁷

Aktualnie dostępne definicje ARDS nie są w stanie odpowiednio identyfikować lub stratyfikować pacjentów pod względem ciężkości i rokowania. Dlatego też poszukuje się bardziej precyzyjnych parametrów prognostycznych, które mogłyby przewidzieć śmiertelność u pacjentów z ARDS.⁸

Optymalne parametry prognostyczne i czas ich oceny

Badania wskazują, że rokowanie pacjentów z ARDS można ustalić w ciągu pierwszych dwóch dni po intubacji. Najlepszą wartość predykcyjną śmiertelności 28-dniowej wykazano dla parametrów ocenianych w 1. i 2. dobie po intubacji (średnie pole pod krzywą ROC dla wszystkich predyktorów/skal: 0,632 i 0,620).⁹¹⁰

Wśród najważniejszych parametrów prognostycznych wymienia się:

Wskaźnik utlenowania (OI – Oxygenation Index) – okazał się najdokładniejszym parametrem do przewidywania śmiertelności w ARDS, zwłaszcza oceniany w 3. dniu po przyjęciu do specjalistycznego ośrodka. Wskaźnik utlenowania ≥15 był związany z wyższą śmiertelnością, dłuższym pobytem w OIT i szpitalu oraz dłuższym czasem wentylacji mechanicznej.¹¹¹²
Pozanaczyniowa woda płucna (EVLWI – Extravascular Lung Water Index) – obok OI jest jednym z najlepszych predyktorów, a ich połączenie daje pola pod krzywą ROC wynoszące 0,801 (dzień 1.) i 0,824 (dzień 2.).¹³
Stosunek PaO₂/FiO₂ – stosunek ciśnienia parcjalnego tlenu we krwi tętniczej do frakcji wdychanego tlenu oceniany 24 godziny (dzień 1.) po standardowym ustawieniu respiratora jest lepszym predyktorem wyników u pacjentów z ARDS niż ten sam współczynnik oceniany w dniu, w którym pacjenci spełnili kryteria berlińskie ARDS (dzień 0.).¹⁴¹⁵
Skala SOFA (Sequential Organ Failure Assessment) – niższy wynik w skali SOFA był niezależnie związany z niższą śmiertelnością 28-dniową. Wykazano, że wynik SOFA ≥10 jest niezależnym predyktorem śmiertelności szpitalnej.¹⁶¹⁷¹⁸
Skala APACHE II – okazała się niezależnym predyktorem śmiertelności szpitalnej w analizach wieloczynnikowych.¹⁹²⁰
Wskaźnik SpO₂/FiO₂ – w analizach wieloczynnikowych okazał się niezależnie związany ze śmiertelnością szpitalną.²¹
Średnie ciśnienie tętnicze (MAP – Mean Arterial Pressure) – okazało się najważniejszą cechą kliniczną do przewidywania 60-dniowej śmiertelności. Pacjenci z podgrupą wysokiego MAP mieli zwiększone ryzyko dysfunkcji metabolicznej i uszkodzeń narządów, co wiązało się z wysoką śmiertelnością.²²²³

Skale prognostyczne w ARDS

Różne skale i modele prognostyczne są wykorzystywane do oceny ryzyka śmiertelności u pacjentów z ARDS:

Skala APPS (Age, PaO₂/FiO₂, Plateau Pressure Score) – model APPS wykazał doskonałą skuteczność w dużej kohorcie kolejnych pacjentów z umiarkowanym i ciężkim ARDS wentylowanych strategią protekcyjnej wentylacji mechanicznej. Wykorzystanie APPS do kierowania stratyfikacją ryzyka pacjentów z ARDS może być ważnym narzędziem do prowadzenia terapii i zwiększania potencjału powodzenia przyszłych badań klinicznych.²⁴²⁵
Modele uczenia maszynowego – wykazują wyższą dokładność w konstruowaniu modeli predykcyjnych w porównaniu z tradycyjnymi algorytmami regresji logistycznej. Algorytmy AI wykazują doskonałą wydajność w przewidywaniu rokowania ARDS, z wyższą czułością i swoistością niż tradycyjne modele. Model losowego lasu (Random Forest) zbudowany na danych klinicznych zebranych w 3. dniu wykazał poprawioną wydajność i skuteczność prognozowania (pole pod krzywą AUC: 0,84).²⁶²⁷²⁸
Model wczesnej predykcji – nowoutworzone modele bazujące na interpretowanym uczeniu maszynowym wykazują dobrą zdolność predykcyjną dla umiarkowanego do ciężkiego ARDS indukowanego przez inhalację i mogą pomóc klinicystom w podejmowaniu decyzji oraz ułatwić rekrutację pacjentów do programów profilaktycznych w celu poprawy ich wyników.²⁹³⁰

Predykcja czasu wentylacji mechanicznej

Przewidywanie czasu trwania wentylacji mechanicznej (MV) po wystąpieniu ARDS jest złożone i nie może być odpowiednio wykonane przez lekarzy intensywnej terapii. Badania wykazały, że wczesna predykcja czasu trwania MV oparta na uczeniu maszynowym jest bardziej dokładna, gdy modele predykcyjne są oparte na cechach klinicznych pacjentów z ARDS w drugiej dobie OIT po wystąpieniu ARDS.³¹

Czynniki wpływające na rokowanie

Różne czynniki mają wpływ na rokowanie pacjentów z ARDS:

Wiek – zaawansowany wiek jest związany z gorszym rokowaniem³²
Przyczyna ARDS – pacjenci z ARDS spowodowanym bezpośrednim uszkodzeniem płuc mają gorsze wyniki niż ci z pośrednimi przyczynami uszkodzenia płuc³³
Choroby współistniejące – przewlekłe schorzenia, w tym choroby wątroby, marskość wątroby, nadużywanie alkoholu i długotrwała immunosupresja, mogą mieć negatywny wpływ na wynik³⁴
Strategia wentylacji – zmniejszenie śmiertelności związanej z ARDS w ciągu ostatnich 20 lat wydaje się być w dużej mierze wyjaśnione zmniejszeniem uszkodzenia płuc indukowanego przez wentylator (VILI)³⁵
Monitorowanie TPTD (termodylucja przezpłucna) – samo monitorowanie TPTD było niezależnie związane ze zmniejszoną śmiertelnością³⁶³⁷
Dodatni bilans płynów – dodatni bilans płynów w ciągu pierwszych 5 dni został zidentyfikowany jako istotny czynnik ryzyka zgonu³⁸
Niewydolność wielonarządowa – liczba niewydolnych narządów jest znaczącym czynnikiem ryzyka zgonu³⁹

Zalecenia terapeutyczne wpływające na rokowanie

Odpowiednie postępowanie terapeutyczne może znacząco wpłynąć na rokowanie pacjentów z ARDS:

Objętość oddechowa – objętość oddechowa około 6 ml/kg przewidywanej masy ciała (PBW) powinna być stosowana jako pierwsze podejście u pacjentów z rozpoznanym ARDS, aby zmniejszyć śmiertelność⁴⁰
Ciśnienie plateau – powinno być stale monitorowane i nie powinno przekraczać 30 cmH₂O, aby zmniejszyć śmiertelność⁴¹
PEEP (dodatnie ciśnienie końcowo-wydechowe) – jest istotnym elementem postępowania w ARDS, a eksperci sugerują stosowanie wartości powyżej 5 cmH₂O u wszystkich pacjentów z ARDS⁴²
Ułożenie na brzuchu – stosowanie ułożenia na brzuchu podczas ARDS było badane w 8 randomizowanych badaniach kontrolowanych⁴³
ECMO (pozaustrojowe natlenianie krwi) – powinno być rozważane w przypadkach ciężkiego ARDS z PaO₂/FiO₂ < 80 mmHg i/lub gdy wentylacja mechaniczna staje się niebezpieczna ze względu na wzrost ciśnienia plateau⁴⁴
Tlenek azotu wziewny – może być stosowany w przypadkach ARDS z głęboką hipoksemią pomimo wdrożenia strategii ochronnej wentylacji i ułożenia na brzuchu, przed rozważeniem zastosowania żylno-żylnego ECMO⁴⁵

Ocena skuteczności leczenia

Eksperci sugerują, że skuteczność i bezpieczeństwo wszystkich parametrów wentylacji oraz metod terapeutycznych związanych z leczeniem ARDS powinny być oceniane co najmniej co 24 godziny.⁴⁶

Odległa obserwacja i rokowanie u osób, które przeżyły ARDS

Większość osób, które przeżyły ARDS, odzyskuje normalną lub bliską normalnej funkcję płuc w ciągu sześciu miesięcy do roku. Jednak niektórzy mogą rozwinąć przewlekłe problemy płucne, które wymagają opieki specjalistów pulmonologów. Zmniejszona funkcja płuc może wpływać na codzienną rutynę i aktywności lub może występować tylko podczas intensywnego wysiłku, na przykład podczas ćwiczeń.⁴⁷

Pacjenci, którzy przeżyli ARDS, zazwyczaj wymagają pewnej formy fizjoterapii w celu odbudowania napięcia mięśniowego. Powrót do zdrowia po ARDS może zająć dużo czasu, a zaawansowane leczenie i podejścia do wentylacji, w tym układanie pacjentów na brzuchu w celu poprawy przepływu tlenu, pomagają coraz większej liczbie osób przeżyć i zmniejszyć powikłania ARDS.⁴⁸

Rokowanie jest zazwyczaj lepsze u osób młodszych (poniżej 65 roku życia) oraz w przypadkach, gdy ARDS jest spowodowany urazem lub transfuzją krwi.⁴⁹

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Materiały źródłowe

#1 Acute respiratory distress syndrome: Prognosis and outcomes in adults – UpToDate
https://www.uptodate.com/contents/acute-respiratory-distress-syndrome-prognosis-and-outcomes-in-adults
Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure characterized by the acute onset of bilateral alveolar opacities and hypoxemia. The prognosis of ARDS is reviewed here. […] ARDS management is largely supportive.
#2 Acute respiratory distress syndrome: Prognosis and outcomes in adults – UpToDate
http://www.uptodate.com/contents/acute-respiratory-distress-syndrome-prognosis-and-outcomes
Acute respiratory distress syndrome (ARDS) is a life-threatening form of respiratory failure characterized by the acute onset of bilateral alveolar opacities and hypoxemia. ARDS management is largely supportive. […] The prognosis of ARDS is reviewed here. […] Mortality rates […] Predictors […] Patient-related […] Age […] Comorbidities […] Disease-related […] Poor gas exchange and disease severity […] Infection and multiorgan failure […] Others […] Treatment-related. […] Morbidity among survivors […] Evaluation and treatment […] Cognitive, psychological, physical dysfunction […] Lung dysfunction […] Other sequalae […] Returning to work.
#3 The APPS: an outcome score for the acute respiratory distress syndrome – Villar – Journal of Thoracic Disease
https://jtd.amegroups.org/article/view/10066/html
It is estimated that about one million patients around the world develop ARDS each year; more than one third of them will not survive the syndrome. […] It has been demonstrated that lung injury severity 24 hours after ARDS onset is a major determinant of outcome. […] Current definitions of ARDS are incapable of properly identifying or stratifying ARDS patients in terms of severity and prognosis. […] The APPS model showed an excellence performance in a large cohort of consecutive patients with moderate and severe ARDS ventilated with a lung protective mechanical ventilation strategy. […] The use of APPS to guide risk stratification of patients with ARDS can be expected to be an important tool for guiding therapy, and for increasing the potential of success of future clinical trials. […] We do not exclude that in the future, incorporating markers of increased pulmonary vascular permeability and right ventricular dysfunction could improve the prognostic accuracy of the APPS.
#4 Acute Respiratory Distress Syndrome (ARDS)
https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards
Survival rates for ARDS are around 55% to 70% when treatment is prompt. If treatment is delayed or other organs begin to fail, survival rates are lower. […] Factors like the underlying medical conditions, health history and how severe the respiratory distress is all go into determining the outlook. Your healthcare provider will tell you what to expect. […] ARDS can be life-threatening and scary. But improved care and ventilator treatments including having people lay face down (prone) to improve oxygen flow are helping more people survive and reduce ARDS complications. The outlook is typically better in people younger than 65 and when trauma or a blood transfusion causes ARDS. […] Recovery from ARDS may take a long time. Most people who are taken off a ventilator can breathe freely. Some recover completely, but others may develop chronic lung problems that require care by lung specialists (pulmonologists). […] Yes, your lungs can recover from ARDS. The exact amount of time varies depending on how much lung damage you have. Most people regain their lung function within two years, although several factors go into that estimate.
#5 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though there is no cure for ARDS, its not uniformly fatal. With treatment, an estimated 60% to 75% of those who have ARDS will survive the disease. […] ARDS is a serious condition. Even with treatment, about 25% to 40% of people with ARDS do not survive. […] In general, people with ARDS caused by direct lung injury have worse outcomes than those with indirect causes of lung injury. Other issues that can have a negative effect on outcome include advanced age and certain chronic medical conditions, including liver disease, cirrhosis, alcohol abuse, and long-term immunosuppression. […] While the mortality rate for ARDS is significant, recent advances in treatment have significantly increased the chances of survival and recovery. Patients who survive ARDS typically require some form of physical therapy to rebuild muscle tone. Most people who survive ARDS go on to recover their normal or close to normal lung function within six months to a year. […] Others may not do as well, particularly if their illness was caused by severe lung damage or their treatment entailed long-term use of a ventilator. Their reduced lung function may affect daily routine and activities, or it may only occur during strenuous activity, for instance, while exercising.
#6 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232720
Early recognition of high-risk-patients with acute respiratory distress syndrome (ARDS) might improve their outcome by less protracted allocation to intensified therapy including extracorporeal membrane oxygenation (ECMO). […] Therefore, our study aimed at characterization of the best predictor and the best day(s) to predict 28-days-mortality within four days after intubation of patients with ARDS. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Prognosis of ARDS-patients can be established within two days after intubation. The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality.
#7 The APPS: an outcome score for the acute respiratory distress syndrome – Villar – Journal of Thoracic Disease
https://jtd.amegroups.org/article/view/10066/html
It is estimated that about one million patients around the world develop ARDS each year; more than one third of them will not survive the syndrome. […] It has been demonstrated that lung injury severity 24 hours after ARDS onset is a major determinant of outcome. […] Current definitions of ARDS are incapable of properly identifying or stratifying ARDS patients in terms of severity and prognosis. […] The APPS model showed an excellence performance in a large cohort of consecutive patients with moderate and severe ARDS ventilated with a lung protective mechanical ventilation strategy. […] The use of APPS to guide risk stratification of patients with ARDS can be expected to be an important tool for guiding therapy, and for increasing the potential of success of future clinical trials. […] We do not exclude that in the future, incorporating markers of increased pulmonary vascular permeability and right ventricular dysfunction could improve the prognostic accuracy of the APPS.
#8 The APPS: an outcome score for the acute respiratory distress syndrome – Villar – Journal of Thoracic Disease
https://jtd.amegroups.org/article/view/10066/html
It is estimated that about one million patients around the world develop ARDS each year; more than one third of them will not survive the syndrome. […] It has been demonstrated that lung injury severity 24 hours after ARDS onset is a major determinant of outcome. […] Current definitions of ARDS are incapable of properly identifying or stratifying ARDS patients in terms of severity and prognosis. […] The APPS model showed an excellence performance in a large cohort of consecutive patients with moderate and severe ARDS ventilated with a lung protective mechanical ventilation strategy. […] The use of APPS to guide risk stratification of patients with ARDS can be expected to be an important tool for guiding therapy, and for increasing the potential of success of future clinical trials. […] We do not exclude that in the future, incorporating markers of increased pulmonary vascular permeability and right ventricular dysfunction could improve the prognostic accuracy of the APPS.
#9 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time
https://pmc.ncbi.nlm.nih.gov/articles/PMC7202606/
Prognosis of ARDS-patients can be established within two days after intubation. […] The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Among the 49 patients with TPTD, EVLWI (4-day-mean AUC=0.696) and OI (4-day-mean AUC=0.695) were the best predictors. […] AUCs were 0.789 for OI on day-1, and 0.786 for EVLWI on day-2. […] In binary regression analysis of patients with TPTD, EVLWI (B=-0.105; Wald=7.294; p=0.007) and OI (B=0.124; Wald=7.435; p=0.006) were independently associated with 28-days-mortality. […] Combining of EVLWI and OI provided ROC-AUCs of 0.801 (day-1) and 0.824 (day-2). […] The use of TPTD-monitoring per se and a lower SOFA-score were independently associated with a lower 28-days-mortality.
#10 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232720
Early recognition of high-risk-patients with acute respiratory distress syndrome (ARDS) might improve their outcome by less protracted allocation to intensified therapy including extracorporeal membrane oxygenation (ECMO). […] Therefore, our study aimed at characterization of the best predictor and the best day(s) to predict 28-days-mortality within four days after intubation of patients with ARDS. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Prognosis of ARDS-patients can be established within two days after intubation. The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality.
#11 Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study | BMC Anesthesiology | Full Text
https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-016-0272-4
Currently there is no ARDS definition or classification system that allows optimal prediction of mortality in ARDS patients. […] The oxygenation index was the most accurate parameter for mortality prediction. […] An oxygenation index of 15 or greater was associated with higher mortality, longer length of stay in ICU and hospital and longer duration of mechanical ventilation. […] The oxygenation index is suggested to be the most suitable parameter to predict mortality in ARDS, preferably assessed on day 3 after admission to a specialized centre. […] In the group of patients with an OI of 15 or greater on day 3, mortality was higher; length of stay (both in the ICU and hospital) and duration of mechanical ventilation were longer. […] OI was found to be the most accurate parameter with respect to predictive validity.
#12 Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study | BMC Anesthesiology | Full Text
https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-016-0272-4
The OI has been proven to be a more suitable parameter to predict mortality of patients suffering from ARDS in national referral centres when compared to PaO2/FiO2 ratio, the AECC or Berlin definition. […] The OI appears to be especially helpful for prediction of mortality on day three after admission to a specialized referral centre, as a response to standardised ARDS treatment may be observed by that time.
#13 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time
https://pmc.ncbi.nlm.nih.gov/articles/PMC7202606/
Prognosis of ARDS-patients can be established within two days after intubation. […] The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Among the 49 patients with TPTD, EVLWI (4-day-mean AUC=0.696) and OI (4-day-mean AUC=0.695) were the best predictors. […] AUCs were 0.789 for OI on day-1, and 0.786 for EVLWI on day-2. […] In binary regression analysis of patients with TPTD, EVLWI (B=-0.105; Wald=7.294; p=0.007) and OI (B=0.124; Wald=7.435; p=0.006) were independently associated with 28-days-mortality. […] Combining of EVLWI and OI provided ROC-AUCs of 0.801 (day-1) and 0.824 (day-2). […] The use of TPTD-monitoring per se and a lower SOFA-score were independently associated with a lower 28-days-mortality.
#14
https://journals.lww.com/md-journal/fulltext/2016/04050/the_ratio_of_partial_pressure_arterial_oxygen_and.88.aspx
The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. […] We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS. […] The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. […] PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0. […] This study aimed to determine whether PaO2/FiO2 ratio 24 h (Day 1) after standard ventilator setting would be a better outcome predictor than the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0).
#15
https://journals.lww.com/md-journal/fulltext/2016/04050/the_ratio_of_partial_pressure_arterial_oxygen_and.88.aspx
The initial severity of ARDS on Day 0 according to Berlin definition was not significantly associated with the outcome. […] By contrast, PaO2/FiO2 ratio on Day 1 following standard ventilator setting was found to be significantly associated with the outcome and thus could separate patients into subgroups with different clinical outcomes. […] All the findings indicated that the PaO2/FiO2 ratio after stabilization might be a more appropriate predictor of death than the initial PaO2/FiO2 ratio at the onset of ARDS. […] In conclusion, PaO2/FiO2 ratio on Day 0 is not a good predictor of outcomes in patients with ARDS. In contrast, a stabilized (24-h delayed) PaO2/FiO2 ratio after applying mechanical ventilator can accurately predict the outcomes in patients with ARDS.
#16 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time
https://pmc.ncbi.nlm.nih.gov/articles/PMC7202606/
Prognosis of ARDS-patients can be established within two days after intubation. […] The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Among the 49 patients with TPTD, EVLWI (4-day-mean AUC=0.696) and OI (4-day-mean AUC=0.695) were the best predictors. […] AUCs were 0.789 for OI on day-1, and 0.786 for EVLWI on day-2. […] In binary regression analysis of patients with TPTD, EVLWI (B=-0.105; Wald=7.294; p=0.007) and OI (B=0.124; Wald=7.435; p=0.006) were independently associated with 28-days-mortality. […] Combining of EVLWI and OI provided ROC-AUCs of 0.801 (day-1) and 0.824 (day-2). […] The use of TPTD-monitoring per se and a lower SOFA-score were independently associated with a lower 28-days-mortality.
#17 Predictive validity of the sequential organ failure assessment score for mortality in patients with acute respiratory distress syndrome in Vietnam | Scientific Reports
https://www.nature.com/articles/s41598-025-92199-y
Evaluating the prognosis of ARDS patients using grading systems can enhance treatment decisions. This retrospective observational study evaluated the predictive accuracy of the SOFA score, APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio for mortality in ARDS patients in Vietnam. […] The SOFA (AUROC: 0.651) and APACHE II scores (AUROC: 0.693) showed poor discriminatory ability for hospital mortality. […] In multivariable analyses, after adjusting for the same set of confounding variables, the APACHE II score (adjusted OR: 1.152), SpO2/FiO2 ratio (adjusted OR: 0.985), and PaO2/FiO2 ratio (adjusted OR: 0.989) were independently associated with hospital mortality. […] Although the SOFA score (adjusted OR: 1.132) indicated a potential association with hospital mortality, it did not reach statistical significance (p=0.081). However, a SOFA score of 10 emerged as an independent predictor (adjusted OR: 3.398) of hospital mortality.
#18 Predictive validity of the sequential organ failure assessment score for mortality in patients with acute respiratory distress syndrome in Vietnam | Scientific Reports
https://www.nature.com/articles/s41598-025-92199-y
Both the SOFA and APACHE II scores demonstrated poor ability to predict hospital mortality upon admission; a positive correlation was observed between these scores and hospital mortality. […] The multivariable logistic regression analyses revealed that, after adjusting for the same set of confounding variables, only the APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio were independently associated with hospital mortality. […] Notably, a SOFA score of 10 was identified as an independent predictor of hospital mortality. […] Overall, the study highlights the importance of the APACHE II score and the SpO2/FiO2 and PaO2/FiO2 ratios as independent predictors of hospital mortality. […] However, the ability of these grading systems to predict hospital mortality is somewhat limited.
#19 Predictive validity of the sequential organ failure assessment score for mortality in patients with acute respiratory distress syndrome in Vietnam | Scientific Reports
https://www.nature.com/articles/s41598-025-92199-y
Evaluating the prognosis of ARDS patients using grading systems can enhance treatment decisions. This retrospective observational study evaluated the predictive accuracy of the SOFA score, APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio for mortality in ARDS patients in Vietnam. […] The SOFA (AUROC: 0.651) and APACHE II scores (AUROC: 0.693) showed poor discriminatory ability for hospital mortality. […] In multivariable analyses, after adjusting for the same set of confounding variables, the APACHE II score (adjusted OR: 1.152), SpO2/FiO2 ratio (adjusted OR: 0.985), and PaO2/FiO2 ratio (adjusted OR: 0.989) were independently associated with hospital mortality. […] Although the SOFA score (adjusted OR: 1.132) indicated a potential association with hospital mortality, it did not reach statistical significance (p=0.081). However, a SOFA score of 10 emerged as an independent predictor (adjusted OR: 3.398) of hospital mortality.
#20 Predictive validity of the sequential organ failure assessment score for mortality in patients with acute respiratory distress syndrome in Vietnam | Scientific Reports
https://www.nature.com/articles/s41598-025-92199-y
Both the SOFA and APACHE II scores demonstrated poor ability to predict hospital mortality upon admission; a positive correlation was observed between these scores and hospital mortality. […] The multivariable logistic regression analyses revealed that, after adjusting for the same set of confounding variables, only the APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio were independently associated with hospital mortality. […] Notably, a SOFA score of 10 was identified as an independent predictor of hospital mortality. […] Overall, the study highlights the importance of the APACHE II score and the SpO2/FiO2 and PaO2/FiO2 ratios as independent predictors of hospital mortality. […] However, the ability of these grading systems to predict hospital mortality is somewhat limited.
#21 Predictive validity of the sequential organ failure assessment score for mortality in patients with acute respiratory distress syndrome in Vietnam | Scientific Reports
https://www.nature.com/articles/s41598-025-92199-y
Evaluating the prognosis of ARDS patients using grading systems can enhance treatment decisions. This retrospective observational study evaluated the predictive accuracy of the SOFA score, APACHE II score, SpO2/FiO2 ratio, and PaO2/FiO2 ratio for mortality in ARDS patients in Vietnam. […] The SOFA (AUROC: 0.651) and APACHE II scores (AUROC: 0.693) showed poor discriminatory ability for hospital mortality. […] In multivariable analyses, after adjusting for the same set of confounding variables, the APACHE II score (adjusted OR: 1.152), SpO2/FiO2 ratio (adjusted OR: 0.985), and PaO2/FiO2 ratio (adjusted OR: 0.989) were independently associated with hospital mortality. […] Although the SOFA score (adjusted OR: 1.132) indicated a potential association with hospital mortality, it did not reach statistical significance (p=0.081). However, a SOFA score of 10 emerged as an independent predictor (adjusted OR: 3.398) of hospital mortality.
#22 Early predictive values of clinical assessments for ARDS mortality: a machine-learning approach | Scientific Reports
https://www.nature.com/articles/s41598-024-68653-8
Acute respiratory distress syndrome (ARDS) is a devastating critical care syndrome with significant morbidity and mortality. The objective of this study was to evaluate the predictive values of dynamic clinical indices by developing machine-learning (ML) models for early and accurate clinical assessment of the disease prognosis of ARDS. […] An RF model trained using clinical data collected at day 3 showed improved performance and prognostication efficacy (area under the curve [AUC]: 0.84, 95% CI: 0.780.89) compared to baseline with an AUC value of 0.72 (95% CI: 0.650.78). […] Thus, clinical features collected early (day 3) improved performance of integrative ML models with better prognostication for mortality. Among these, MAP represented the most important feature for ARDS patients early risk stratification.
#23 Early predictive values of clinical assessments for ARDS mortality: a machine-learning approach | Scientific Reports
https://www.nature.com/articles/s41598-024-68653-8
In this study, we found that MAP was the most significant clinical characteristic for predicting 60-day death, along with other crucial clinical features. […] Our results suggested seven clinical parameters (MAP, bicarbonate, age, platelet count, albumin, heart rate and glucose) were the most important features at day 3 for ARDS mortality risk in the FACTT trial. […] The RF classifier consistently demonstrated outstanding performance at both days, and obtained the highest AUC value of 0.84 at day 3. […] Given its emerging significance in ARDS prognostication, in the following section, we further evaluated the association between elevated MAP and organ dysfunction among non-survivors. […] In our study, we confirmed: (1) ARDS patients in the MAPhigh subgroup had increased risk of metabolic dysfunction and organ injuries associated with high mortality rate (P0.001, Supplementary table S3); and (2) utilizing mechanical ventilation parameters such as MAP collected at day 3 after treatment could provide better prognostic value for ARDS mortality.
#24 The APPS: an outcome score for the acute respiratory distress syndrome – Villar – Journal of Thoracic Disease
https://jtd.amegroups.org/article/view/10066/8945
It is estimated that about one million patients around the world develop ARDS each year; more than one third of them will not survive the syndrome (3). […] It has been demonstrated that lung injury severity 24 hours after ARDS onset is a major determinant of outcome (4). […] Current definitions of ARDS are incapable of properly identifying or stratifying ARDS patients in terms of severity and prognosis (4). […] The APPS model showed an excellence performance in a large cohort of consecutive patients with moderate and severe ARDS ventilated with a lung protective mechanical ventilation strategy. […] The use of APPS to guide risk stratification of patients with ARDS can be expected to be an important tool for guiding therapy, and for increasing the potential of success of future clinical trials. […] We do not exclude that in the future, incorporating markers of increased pulmonary vascular permeability and right ventricular dysfunction could improve the prognostic accuracy of the APPS.
#25 The APPS: an outcome score for the acute respiratory distress syndrome – Villar – Journal of Thoracic Disease
https://jtd.amegroups.org/article/view/10066/html
It is estimated that about one million patients around the world develop ARDS each year; more than one third of them will not survive the syndrome. […] It has been demonstrated that lung injury severity 24 hours after ARDS onset is a major determinant of outcome. […] Current definitions of ARDS are incapable of properly identifying or stratifying ARDS patients in terms of severity and prognosis. […] The APPS model showed an excellence performance in a large cohort of consecutive patients with moderate and severe ARDS ventilated with a lung protective mechanical ventilation strategy. […] The use of APPS to guide risk stratification of patients with ARDS can be expected to be an important tool for guiding therapy, and for increasing the potential of success of future clinical trials. […] We do not exclude that in the future, incorporating markers of increased pulmonary vascular permeability and right ventricular dysfunction could improve the prognostic accuracy of the APPS.
#26 Comparison of artificial intelligence and logistic regression models for mortality prediction in acute respiratory distress syndrome: a systematic review and meta-analysis | Intensive Care Medicine Experimental | Full Text
https://icm-experimental.springeropen.com/articles/10.1186/s40635-024-00706-8
The application of artificial intelligence (AI) in predicting the mortality of acute respiratory distress syndrome (ARDS) has garnered significant attention. […] The AI algorithms showed superior performance in predicting the mortality of ARDS patients and demonstrated strong potential for clinical application. Additionally, we found that for ARDS, a highly heterogeneous condition, the accuracy of the model is influenced by the severity of the disease. […] Our research suggests that AI algorithms exhibit higher accuracy in constructing predictive models compared to traditional LR algorithms. This increased accuracy is largely attributed to the superior computational power and precise data processing capabilities of AI algorithms. […] The results reveal that the predictive capability of AI algorithms indeed surpasses that of LR algorithms.
#27 Comparison of artificial intelligence and logistic regression models for mortality prediction in acute respiratory distress syndrome: a systematic review and meta-analysis | Intensive Care Medicine Experimental | Full Text
https://icm-experimental.springeropen.com/articles/10.1186/s40635-024-00706-8
In our study, the accuracy of the diagnostic model varied significantly across different ARDS severity cohorts. […] This meta-analysis demonstrates that AI-based models exhibit excellent performance in predicting the prognosis of ARDS, with both sensitivity and specificity surpassing those of traditional LR models. AI-based models hold significant potential for clinical application and could serve as a valuable adjunct tool to assist clinicians in making earlier interventions.
#28 Early predictive values of clinical assessments for ARDS mortality: a machine-learning approach | Scientific Reports
https://www.nature.com/articles/s41598-024-68653-8
Acute respiratory distress syndrome (ARDS) is a devastating critical care syndrome with significant morbidity and mortality. The objective of this study was to evaluate the predictive values of dynamic clinical indices by developing machine-learning (ML) models for early and accurate clinical assessment of the disease prognosis of ARDS. […] An RF model trained using clinical data collected at day 3 showed improved performance and prognostication efficacy (area under the curve [AUC]: 0.84, 95% CI: 0.780.89) compared to baseline with an AUC value of 0.72 (95% CI: 0.650.78). […] Thus, clinical features collected early (day 3) improved performance of integrative ML models with better prognostication for mortality. Among these, MAP represented the most important feature for ARDS patients early risk stratification.
#29 Early prediction of moderate-to-severe condition of inhalation-induced acute respiratory distress syndrome via interpretable machine learning | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-01963-7
Several studies have investigated the correlation between physiological parameters and the risk of acute respiratory distress syndrome (ARDS), in addition, etiology-associated heterogeneity in ARDS has become an emerging topic quite recently; however, the intersection between the two, which is early prediction of target conditions in etiology-specific ARDS, has not been well-studied. […] Acute respiratory distress syndrome (ARDS) is life-threatening and the major cause of morbidity and mortality in intensive care units (ICUs), with a mortality rate exceeding 40%. […] Therefore, early prediction of patients with a high risk for developing moderate-to-severe ARDS and the use of prevention strategies for such patients are of great value in critical care units. […] This newly established random forest-based interpretable model shows good predictive ability for moderate-to-severe inhalation-induced ARDS and may assist clinicians in decision-making, as well as facilitate the enrolment of patients in prevention programmes to improve their outcomes.
#30 Early prediction of moderate-to-severe condition of inhalation-induced acute respiratory distress syndrome via interpretable machine learning | BMC Pulmonary Medicine | Full Text
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-022-01963-7
The primary outcome of interest in this study was the ratio of partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2 ratio) 6 h since investigation. ARDS was diagnosed according to the Berlin definition established in 2012. […] The final model (i.e., Four-Var RF) demonstrated an area under the ROC curve (AUROC) of 0.9127 (95% confidence interval [CI] 0.87130.9542) and 0.9026 (95% confidence interval [CI] 0.80751) for early ARDS prediction with the independent validation sets (PLAGH, MIMIC-III) 6 h prior to the onset of moderate or severe ARDS. […] In this study, we developed a machine-learning model for the early prediction of inhalation-induced ARDS (moderate-to-severe condition) at 6 h prior to onset in critical care units. […] Rather than providing a binary outcome, our model is able to calculate the likelihood of developing moderate-to-severe ARDS. […] In conclusion, as clinical instances accumulate and clinical records become more comprehensive, this study forms a basis for evaluating the effectiveness of personalised intervention (e.g. vital sign-directed therapy).
#31 Predicting Duration of Mechanical Ventilation in Acute Respiratory Distress Syndrome Using Supervised Machine Learning
https://www.mdpi.com/2077-0383/10/17/3824
Predicting MV duration after ARDS onset over time is complex and cannot be adequately performed by critical care physicians. […] Our findings showed that the ML-based early prediction of MV duration is more accurate when predictive models are based on the clinical features of ARDS patients in the second ICU day after ARDS onset. […] The best early prediction model was obtained with data captured in the 2nd day. […] Supervised ML can make early and accurate predictions of MV duration in ARDS after onset over time across ICUs. […] An early predictive model for MV duration can optimize ICU-level resource utilization. […] The prediction results of LightGBM models based on the data of the second ICU day are very close to those corresponding results of LightGBM models based on the data of the third ICU day. […] This means that MV duration can be predicted earlier, and this could lead to better allocation of MV resources, reducing high acute costs of MV in ARDS, and improving patient care.
#32 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though there is no cure for ARDS, its not uniformly fatal. With treatment, an estimated 60% to 75% of those who have ARDS will survive the disease. […] ARDS is a serious condition. Even with treatment, about 25% to 40% of people with ARDS do not survive. […] In general, people with ARDS caused by direct lung injury have worse outcomes than those with indirect causes of lung injury. Other issues that can have a negative effect on outcome include advanced age and certain chronic medical conditions, including liver disease, cirrhosis, alcohol abuse, and long-term immunosuppression. […] While the mortality rate for ARDS is significant, recent advances in treatment have significantly increased the chances of survival and recovery. Patients who survive ARDS typically require some form of physical therapy to rebuild muscle tone. Most people who survive ARDS go on to recover their normal or close to normal lung function within six months to a year. […] Others may not do as well, particularly if their illness was caused by severe lung damage or their treatment entailed long-term use of a ventilator. Their reduced lung function may affect daily routine and activities, or it may only occur during strenuous activity, for instance, while exercising.
#33 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though there is no cure for ARDS, its not uniformly fatal. With treatment, an estimated 60% to 75% of those who have ARDS will survive the disease. […] ARDS is a serious condition. Even with treatment, about 25% to 40% of people with ARDS do not survive. […] In general, people with ARDS caused by direct lung injury have worse outcomes than those with indirect causes of lung injury. Other issues that can have a negative effect on outcome include advanced age and certain chronic medical conditions, including liver disease, cirrhosis, alcohol abuse, and long-term immunosuppression. […] While the mortality rate for ARDS is significant, recent advances in treatment have significantly increased the chances of survival and recovery. Patients who survive ARDS typically require some form of physical therapy to rebuild muscle tone. Most people who survive ARDS go on to recover their normal or close to normal lung function within six months to a year. […] Others may not do as well, particularly if their illness was caused by severe lung damage or their treatment entailed long-term use of a ventilator. Their reduced lung function may affect daily routine and activities, or it may only occur during strenuous activity, for instance, while exercising.
#34 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though there is no cure for ARDS, its not uniformly fatal. With treatment, an estimated 60% to 75% of those who have ARDS will survive the disease. […] ARDS is a serious condition. Even with treatment, about 25% to 40% of people with ARDS do not survive. […] In general, people with ARDS caused by direct lung injury have worse outcomes than those with indirect causes of lung injury. Other issues that can have a negative effect on outcome include advanced age and certain chronic medical conditions, including liver disease, cirrhosis, alcohol abuse, and long-term immunosuppression. […] While the mortality rate for ARDS is significant, recent advances in treatment have significantly increased the chances of survival and recovery. Patients who survive ARDS typically require some form of physical therapy to rebuild muscle tone. Most people who survive ARDS go on to recover their normal or close to normal lung function within six months to a year. […] Others may not do as well, particularly if their illness was caused by severe lung damage or their treatment entailed long-term use of a ventilator. Their reduced lung function may affect daily routine and activities, or it may only occur during strenuous activity, for instance, while exercising.
#35 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress syndrome (ARDS) at the early phase in adults are proposed. […] Hospital mortality, which increased with the severity of ARDS, was about 40%, and reached 45% in patients presenting with severe ARDS. […] One of the most important results of the LUNG SAFE study was that ARDS was not identified as such by the primary care clinician in almost 40% of cases. […] The reduction in mortality associated with ARDS over the last 20 years seems to be explained largely by a decrease in ventilator-induced lung injury (VILI). […] The current SRLF guidelines are more than 20 years old and so there was a pressing need to update them. […] The experts suggest that the efficacy and safety of all ventilation parameters and therapeutics associated with ARDS management should be evaluated at least every 24 h.
#36 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time
https://pmc.ncbi.nlm.nih.gov/articles/PMC7202606/
Prognosis of ARDS-patients can be established within two days after intubation. […] The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Among the 49 patients with TPTD, EVLWI (4-day-mean AUC=0.696) and OI (4-day-mean AUC=0.695) were the best predictors. […] AUCs were 0.789 for OI on day-1, and 0.786 for EVLWI on day-2. […] In binary regression analysis of patients with TPTD, EVLWI (B=-0.105; Wald=7.294; p=0.007) and OI (B=0.124; Wald=7.435; p=0.006) were independently associated with 28-days-mortality. […] Combining of EVLWI and OI provided ROC-AUCs of 0.801 (day-1) and 0.824 (day-2). […] The use of TPTD-monitoring per se and a lower SOFA-score were independently associated with a lower 28-days-mortality.
#37 Prediction of outcome in patients with ARDS: A prospective cohort study comparing ARDS-definitions and other ARDS-associated parameters, ratios and scores at intubation and over time | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232720
Early recognition of high-risk-patients with acute respiratory distress syndrome (ARDS) might improve their outcome by less protracted allocation to intensified therapy including extracorporeal membrane oxygenation (ECMO). […] Therefore, our study aimed at characterization of the best predictor and the best day(s) to predict 28-days-mortality within four days after intubation of patients with ARDS. […] In the totality of patients the best prediction of 28-days-mortality was found on day-1 and day-2 (mean ROC-AUCs for all predictors/scores: 0.632 and 0.620). […] Prognosis of ARDS-patients can be established within two days after intubation. The best predictors were EVLWI and OI and their combination. TPTD-monitoring per se was independently associated with reduced mortality.
#38
https://journals.lww.com/md-journal/fulltext/2016/04050/the_ratio_of_partial_pressure_arterial_oxygen_and.88.aspx
The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. […] We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS. […] The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. […] PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0. […] This study aimed to determine whether PaO2/FiO2 ratio 24 h (Day 1) after standard ventilator setting would be a better outcome predictor than the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0).
#39
https://journals.lww.com/md-journal/fulltext/2016/04050/the_ratio_of_partial_pressure_arterial_oxygen_and.88.aspx
The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. […] We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS. […] The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. […] PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0. […] This study aimed to determine whether PaO2/FiO2 ratio 24 h (Day 1) after standard ventilator setting would be a better outcome predictor than the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0).
#40 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
A tidal volume around 6 mL/kg of predicted body weight (PBW) should be used as a first approach in patients with recognized ARDS, in the absence of severe metabolic acidosis, including those with mild ARDS, to reduce mortality. […] Plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] A high plateau pressure is an independent mortality risk factor, as it reflects either great severity (associated with poor lung compliance) or inadequate mechanical ventilation. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] The use of prone positioning (PP) during ARDS has been studied in 8 randomized controlled trials, 5 of which were large, and the most recent meta-analysis concluded that there was no statistically significant difference in mortality between the PP group and the supine position group.
#41 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
A tidal volume around 6 mL/kg of predicted body weight (PBW) should be used as a first approach in patients with recognized ARDS, in the absence of severe metabolic acidosis, including those with mild ARDS, to reduce mortality. […] Plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] A high plateau pressure is an independent mortality risk factor, as it reflects either great severity (associated with poor lung compliance) or inadequate mechanical ventilation. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] The use of prone positioning (PP) during ARDS has been studied in 8 randomized controlled trials, 5 of which were large, and the most recent meta-analysis concluded that there was no statistically significant difference in mortality between the PP group and the supine position group.
#42 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
A tidal volume around 6 mL/kg of predicted body weight (PBW) should be used as a first approach in patients with recognized ARDS, in the absence of severe metabolic acidosis, including those with mild ARDS, to reduce mortality. […] Plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] A high plateau pressure is an independent mortality risk factor, as it reflects either great severity (associated with poor lung compliance) or inadequate mechanical ventilation. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] The use of prone positioning (PP) during ARDS has been studied in 8 randomized controlled trials, 5 of which were large, and the most recent meta-analysis concluded that there was no statistically significant difference in mortality between the PP group and the supine position group.
#43 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
A tidal volume around 6 mL/kg of predicted body weight (PBW) should be used as a first approach in patients with recognized ARDS, in the absence of severe metabolic acidosis, including those with mild ARDS, to reduce mortality. […] Plateau pressure should be monitored continuously and should not exceed 30 cmH2O to reduce mortality. […] A high plateau pressure is an independent mortality risk factor, as it reflects either great severity (associated with poor lung compliance) or inadequate mechanical ventilation. […] PEEP is an essential component of the management of ARDS and the experts suggest using a value above 5 cmH2O in all patients presenting with ARDS. […] The use of prone positioning (PP) during ARDS has been studied in 8 randomized controlled trials, 5 of which were large, and the most recent meta-analysis concluded that there was no statistically significant difference in mortality between the PP group and the supine position group.
#44 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
Venovenous extracorporeal membrane oxygenation (ECMO) should probably be considered in cases of severe ARDS with PaO2/FiO2 < 80 mmHg and/or when mechanical ventilation becomes dangerous because of the increase in plateau pressure and despite optimization of ARDS management including high PEEP, neuromuscular blocking agents, and prone positioning. [...] Inhaled nitric oxide can be used in cases of ARDS with deep hypoxemia despite the implementation of a protective ventilation strategy and prone positioning, and before envisaging use of venovenous ECMO.
#45 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
Venovenous extracorporeal membrane oxygenation (ECMO) should probably be considered in cases of severe ARDS with PaO2/FiO2 < 80 mmHg and/or when mechanical ventilation becomes dangerous because of the increase in plateau pressure and despite optimization of ARDS management including high PEEP, neuromuscular blocking agents, and prone positioning. [...] Inhaled nitric oxide can be used in cases of ARDS with deep hypoxemia despite the implementation of a protective ventilation strategy and prone positioning, and before envisaging use of venovenous ECMO.
#46 Formal guidelines: management of acute respiratory distress syndrome | Annals of Intensive Care | Full Text
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0540-9
Fifteen recommendations and a therapeutic algorithm regarding the management of acute respiratory distress syndrome (ARDS) at the early phase in adults are proposed. […] Hospital mortality, which increased with the severity of ARDS, was about 40%, and reached 45% in patients presenting with severe ARDS. […] One of the most important results of the LUNG SAFE study was that ARDS was not identified as such by the primary care clinician in almost 40% of cases. […] The reduction in mortality associated with ARDS over the last 20 years seems to be explained largely by a decrease in ventilator-induced lung injury (VILI). […] The current SRLF guidelines are more than 20 years old and so there was a pressing need to update them. […] The experts suggest that the efficacy and safety of all ventilation parameters and therapeutics associated with ARDS management should be evaluated at least every 24 h.
#47 Acute Respiratory Distress Syndrome (ARDS) > Fact Sheets > Yale Medicine
https://www.yalemedicine.org/conditions/ards
Though there is no cure for ARDS, its not uniformly fatal. With treatment, an estimated 60% to 75% of those who have ARDS will survive the disease. […] ARDS is a serious condition. Even with treatment, about 25% to 40% of people with ARDS do not survive. […] In general, people with ARDS caused by direct lung injury have worse outcomes than those with indirect causes of lung injury. Other issues that can have a negative effect on outcome include advanced age and certain chronic medical conditions, including liver disease, cirrhosis, alcohol abuse, and long-term immunosuppression. […] While the mortality rate for ARDS is significant, recent advances in treatment have significantly increased the chances of survival and recovery. Patients who survive ARDS typically require some form of physical therapy to rebuild muscle tone. Most people who survive ARDS go on to recover their normal or close to normal lung function within six months to a year. […] Others may not do as well, particularly if their illness was caused by severe lung damage or their treatment entailed long-term use of a ventilator. Their reduced lung function may affect daily routine and activities, or it may only occur during strenuous activity, for instance, while exercising.
#48 Acute Respiratory Distress Syndrome (ARDS)
https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards
Survival rates for ARDS are around 55% to 70% when treatment is prompt. If treatment is delayed or other organs begin to fail, survival rates are lower. […] Factors like the underlying medical conditions, health history and how severe the respiratory distress is all go into determining the outlook. Your healthcare provider will tell you what to expect. […] ARDS can be life-threatening and scary. But improved care and ventilator treatments including having people lay face down (prone) to improve oxygen flow are helping more people survive and reduce ARDS complications. The outlook is typically better in people younger than 65 and when trauma or a blood transfusion causes ARDS. […] Recovery from ARDS may take a long time. Most people who are taken off a ventilator can breathe freely. Some recover completely, but others may develop chronic lung problems that require care by lung specialists (pulmonologists). […] Yes, your lungs can recover from ARDS. The exact amount of time varies depending on how much lung damage you have. Most people regain their lung function within two years, although several factors go into that estimate.
#49 Acute Respiratory Distress Syndrome (ARDS)
https://my.clevelandclinic.org/health/diseases/15283-acute-respiratory-distress-syndrome-ards
Survival rates for ARDS are around 55% to 70% when treatment is prompt. If treatment is delayed or other organs begin to fail, survival rates are lower. […] Factors like the underlying medical conditions, health history and how severe the respiratory distress is all go into determining the outlook. Your healthcare provider will tell you what to expect. […] ARDS can be life-threatening and scary. But improved care and ventilator treatments including having people lay face down (prone) to improve oxygen flow are helping more people survive and reduce ARDS complications. The outlook is typically better in people younger than 65 and when trauma or a blood transfusion causes ARDS. […] Recovery from ARDS may take a long time. Most people who are taken off a ventilator can breathe freely. Some recover completely, but others may develop chronic lung problems that require care by lung specialists (pulmonologists). […] Yes, your lungs can recover from ARDS. The exact amount of time varies depending on how much lung damage you have. Most people regain their lung function within two years, although several factors go into that estimate.