1. Rapidly improving ARDS differs clinically and biologically from persistent ARDS.
- Author
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Valda Toro, Patricia, Willmore, Andrew, Wu, Nelson, Jauregui, Alejandra, Sinha, Pratik, Liu, Kathleen, Hendrickson, Carolyn, Sarma, Aartik, Neyton, Lucile, Leligdowicz, Aleksandra, Matthay, Michael, Calfee, Carolyn, Zhuo, Hanjing, Jones, Chayse, Kangelaris, Kirsten, Delucchi, Kevin, Langelier, Charles, and Gomez, Antonio
- Subjects
Acute respiratory distress syndrome ,Hypoinflammatory and hyperinflammatory ARDS phenotypes ,Precision medicine ,Prognostic and predictive enrichment of clinical trials ,Rapidly improving acute respiratory distress syndrome ,Humans ,Respiratory Distress Syndrome ,Male ,Female ,Middle Aged ,Prospective Studies ,Aged ,Biomarkers ,Respiration ,Artificial ,Adult ,Cohort Studies ,Hypoxia - Abstract
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) PaO2:FiO2 > 300 or (ii) SpO2: FiO2 > 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
- Published
- 2024