ScienceOpenSep 4, 2025

'Validation of Global Definition of Acute Respiratory Distress Syndrome in COVID-19 Patients: A Retrospective Study' - a #JaypeeJournals 'Preventive and Emergency Medicine Insights' publication on #ScienceOpen:

📄🔓 https://www.scienceopen.com/document?vid=ef4064ab-03e0-469c-a83e-efd50f96cce2

#ARDS #GlobalARDSDefinition #HFNO #CriticalCare #COVID19Research

Validation of Global Definition of Acute Respiratory Distress Syndrome in COVID-19 Patients: A Retrospective Study

<div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e180"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e181">Background and aims</h5> <p dir="auto" id="d893418e183">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. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e185"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e186">Patients and methods</h5> <p dir="auto" id="d893418e188">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 H <sub>2</sub>O), or invasive mechanical ventilation (at least a PEEP of 5 cm H <sub>2</sub>O) were included in this study provided they fulfilled oxygenation and radiological criteria of ARDS as per Berlin definition. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e196"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e197">Results</h5> <p dir="auto" id="d893418e199">All-cause hospital mortality rate in patients who fulfilled Berlin definition ( <i>n</i> = 193) was 47.6% (mild ARDS), 64.9% (moderate ARDS), and 67.9% (severe ARDS) ( <i>p</i> = 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), <i>p</i> = 0.007) after adjustment for age, Charlson comorbidity index, and baseline PaO <sub>2</sub>/FiO <sub>2</sub> 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 ( <i>p</i> = 0.024). However, no difference was observed in patients of mild ( <i>p</i> = 0.39) and severe ARDS ( <i>p</i> = 0.24). </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e226"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e227">Conclusion</h5> <p dir="auto" id="d893418e229">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. </p> </div><div xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="section"> <a class="named-anchor" id="d893418e231"> <!-- named anchor --> </a> <h5 class="section-title" id="d893418e232">How to cite this article</h5> <p dir="auto" id="d893418e234">Maitra S, Baidya DK, Ray BR, Kayina CA, Haritha D, Nair PR, <i>et al</i>. 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. </p> </div>

ScienceOpen
Intensive Care MedicineJun 16, 2023
ESICM guidelines on acute respiratory distress syndrome, from definition & phenotyping to respiratory support strategies:
🫁 #ARDS definition
🫁 phenotyping
🫁 high‑flow nasal oxygen #HFNO
🫁 CPAP/NIV
🫁 low tidal volume ventilation
🫁 PEEP & recruitment maneuvers
🫁 prone positioning
🫁 neuromuscular blocking agents
🫁 extracorporeal life support #ECMO #ECLS #ECCO2r
Open access #FOAMcc on @yourICM
🖇️ https://bit.ly/43J1OCe
ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies - Intensive Care Medicine

The aim of these guidelines is to update the 2017 clinical practice guideline (CPG) of the European Society of Intensive Care Medicine (ESICM). The scope of this CPG is limited to adult patients and to non-pharmacological respiratory support strategies across different aspects of acute respiratory distress syndrome (ARDS), including ARDS due to coronavirus disease 2019 (COVID-19). These guidelines were formulated by an international panel of clinical experts, one methodologist and patients’ representatives on behalf of the ESICM. The review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of evidence and grade recommendations and the quality of reporting of each study based on the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) network guidelines. The CPG addressed 21 questions and formulates 21 recommendations on the following domains: (1) definition; (2) phenotyping, and respiratory support strategies including (3) high-flow nasal cannula oxygen (HFNO); (4) non-invasive ventilation (NIV); (5) tidal volume setting; (6) positive end-expiratory pressure (PEEP) and recruitment maneuvers (RM); (7) prone positioning; (8) neuromuscular blockade, and (9) extracorporeal life support (ECLS). In addition, the CPG includes expert opinion on clinical practice and identifies the areas of future research.

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