Acute Respiratory Distress Syndrome in Burn Patients

Abstract

The purpose of this study was to compare the Berlin definition to the American-European Consensus Conference (AECC) definition in determining the prevalence of acute respiratory distress syndrome (ARDS) and associated mortality in the critically ill burn population. Consecutive patients admitted to our institution with burn injury that required mechanical ventilation for more than 24 hours were included for analysis. Included patients (N = 891) were classified by both definitions. The median age, % TBSA burn, and injury severity score (interquartile ranges) were 35 (24-51), 25 (11-45), and 18 (9-26), respectively. Inhalation injury was present in 35.5%. The prevalence of ARDS was 34% using the Berlin definition and 30.5% using the AECC definition (combined acute lung injury and ARDS), with associated mortality rates of 40.9 and 42.9%, respectively. Under the Berlin definition, mortality rose with increased ARDS severity (14.6% no ARDS; 16.7% mild; 44% moderate; and 59.7% severe, P < 0.001). By contrast, under the AECC definition increased mortality was seen only for ARDS category (14.7% no ARDS; 15.1% acute lung injury; and 46.0% ARDS, P < 0.001). The mortality of the 22 subjects meeting the AECC, but not the Berlin definition was not different from patients without ARDS (P = .91). The Berlin definition better stratifies ARDS in terms of severity and correctly excludes those with minimal disease previously captured by the AECC.

Acute Respiratory Distress Syndrome following Cardiac Surgery: Comparison of the American-European Consensus Conference Definition versus the Berlin Definition

“…In a cohort of burn patients who developed ARDS, Bordes et al [29] described identical prevalence rates and ICU mortality: 26.5 and 25%, respectively. Also, in burn patients, Sine et al [30] found that the prevalence of ARDS was 34% using the Berlin definition and 30.5% using the AECC definition (ALI and ARDS combined), with very similar associated mortality rates of 40.9 and 42.9%, respectively. In a large cohort of critically ill ICU patients in Brazil, Caser et al [31] did not found a difference between the AECC and the Berlin definition regarding incidence and mortality.…”

ARDS after Cardiac Surgery: Is It a Problem, a Problem of Definition, or Both?

“…Thus, based on this study, it cannot be concluded that the AECC and Berlin definitions are nearly equivalent to diagnose ARDS in all intensive-care-unit (ICU) patient populations. Of note, a similar comparison between the two definitions has recently been performed in a cohort of burn patients [8], another very specific subgroup of ICU patients. The Berlin definition was also slightly more sensitive in this subgroup of patients with an ARDS prevalence of 34% compared to 30.5% (including ALI).…”

Significance of vascular endothelium growth factor testing in exhaled breath condensate of patients with acute respiratory distress syndrome

“…Patients met the 2012 ARDS Berlin diagnostic criteria [ 7 ]. The patients were classified into the mild ARDS (200 mmHg PaO /FiO 300 mmHg) and moderate-severe ARDS groups (PaO /FiO 200 mmHg) in accordance with the oxygenation index [ 8 ]. The mortality rate among the patients was 32.3% given that 10 out of the 31 ARDS patients died.…”