Hospital Incidence and Outcomes of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition

Riviello, Elisabeth D.; Kiviri, Willy; Twagirumugabe, Théogène; Mueller, Ariel; Banner‐Goodspeed, Valerie; Officer, Laurent; Novack, Victor; Mutumwinka, Marguerite; Talmor, Daniel; Fowler, Robert

doi:10.1164/rccm.201503-0584oc

Cited by 324 publications

(245 citation statements)

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“…Bilateral chest opacities were evaluated through the routine use of chest ultrasonography, whereas chest radiographs were considered when available. The use of ultrasonography was supported by previous evidence [21]: B-lines and/or lung consolidation without pleural effusion in at [17]. In this African population the most common causes of ARDS were infection, surgery and trauma.…”

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confidence: 60%

“…In a second recent article in the field of ARDS epidemiology and definition, RIVIELLO et al [17] explored the incidence of ARDS in a Rwandan university hospital holding most of the mechanical ventilators existing in a country with >12 million inhabitants [18]. The epidemiology of ARDS in low-income countries has never been reported before.…”

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confidence: 99%

“…However, this study clearly showed that the Berlin definition is not suitable in resource-constrained settings with difficult access to arterial blood gas data, chest radiography and mechanical ventilation. The authors developed a modification of the Berlin criteria to define ARDS (Kigali ARDS) [17]. Table 1 compares the Berlin [5], Kigali [17] and previous American-European consensus definition [19].…”

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confidence: 99%

“…The authors developed a modification of the Berlin criteria to define ARDS (Kigali ARDS) [17]. Table 1 compares the Berlin [5], Kigali [17] and previous American-European consensus definition [19]. The Kigali ARDS definition maintains the same time frame of 1 week and origin of oedema criteria of the Berlin definition.…”

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Acute respiratory distress syndrome

2017

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Since its first description, the acute respiratory distress syndrome (ARDS) has been acknowledged to be a major clinical problem in respiratory medicine. From July 2015 to July 2016 almost 300 indexed articles were published on ARDS. This review summarises only eight of them as an arbitrary overview of clinical relevance: definition and epidemiology, risk factors, prevention and treatment. A strict application of definition criteria is crucial, but the diverse resource-setting scenarios foster geographic variability and contrasting outcome data. A large international multicentre prospective cohort study including 50 countries across five continents reported that ARDS is underdiagnosed, and there is potential for improvement in its management. Furthermore, epidemiological data from low-income countries suggest that a revision of the current definition of ARDS is needed in order to improve its recognition and global clinical outcome. In addition to the well-known risk-factors for ARDS, exposure to high ozone levels and low vitamin D plasma concentrations were found to be predisposing circumstances. Drug-based preventive strategies remain a major challenge, since two recent trials on aspirin and statins failed to reduce the incidence in atrisk patients. A new disease-modifying therapy is awaited: some recent studies promised to improve the prognosis of ARDS, but mortality and disabling complications are still high in survivors in intensive care. Definition and epidemiologySince its first description by ASHBAUGH et al. [1] in 1967, the acute respiratory distress syndrome (ARDS) has been widely recognised as a major clinical problem worldwide, carrying a high morbidity and mortality burden [2][3][4]. Although the recent Berlin definition [5] is probably much better than previous ones, there is still a high variability in both epidemiology and clinical outcomes in diverse healthcare settings [4]. In fact, the incidence of ARDS ranges from 1.5 cases per 100 000 [2] to nearly 79 cases per 100 000 [3], with European countries reporting a lower incidence than USA [6]. Moreover, studies from Brazil reported incidence rates ranging from 1.8 to 31 per 100 000 [7,8].Although the overall survival rate is improving [9,10], there is a notable difference when considering in-hospital mortality over several observational studies [2][3][4][8][9][10][11]. This may be explained by differences in risk factors, availability of diagnostics, ability to recognise ARDS and some selection biases affecting clinical trials [12]. Recently, a large international observational study (the LUNG SAFE trial) evaluated the incidence of ARDS across 459 intensive care units (ICUs) in 50 countries [13]. To assess the clinical recognition of ARDS according to the latest definition, any patient inclusion into the trial was made through a computer algorithm following the Berlin criteria [5], and then compared to the diagnosis made by the attending physicians. Among 4499 patients who developed acute hypoxaemic respiratory failure, ARDS occurred in 1...

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Acute respiratory distress syndrome

2017

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“…However, patients who did not receive positive‐pressure mechanical ventilation but who had a P/F ratio of ≤300 were included in the present study. If the patient was not supported by a mechanical ventilator, the F I O 2 level was calculated as follows: oxygen flow (L/min) × 0.03 + 0.21 10. The common risk factors for ARDS were defined as aspiration, diffuse pulmonary infection, near‐drowning, toxic inhalation, lung contusion, non‐pulmonary sepsis, severe non‐thoracic trauma, pancreatitis, severe burns, non‐cardiogenic shock, drug overdose, hypertransfusion for emergency resuscitation, and cardiopulmonary bypass 1, 2…”

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High‐dose steroid therapy for acute respiratory distress syndrome lacking common risk factors: predictors of outcome

Kinoshita

Ishii

Kushima

et al. 2017

Acute Medicine & Surgery

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AimAcute respiratory distress syndrome (ARDS) is a life‐threatening lung disease that usually occurs in patients with the underling risk factors that triggers lung inflammation. We sometimes encounter patients with ARDS lacking common risk factors. Recent studies have indicated the effectiveness of corticosteroids for this cohort. However, the characteristics of survivors with ARDS who lack common risk factors, and who received high‐dose methylprednisolone pulse therapy (MPPT), are not known.MethodsWe undertook a retrospective study of patients with ARDS lacking common risk factors, who received i.v. MPPT for 3 days. The patients (n = 46) were classified into two groups, survivors (n = 23) and non‐survivors (n = 23), based on their survival at 60 days after the initiation of MPPT, and their clinical and radiological parameters were evaluated.ResultsThe patient characteristics and disease severity of the two groups were comparable. The percentage of consolidation/(ground‐glass attenuation [GGA] + consolidation) on the chest computed tomography scans of survivors was significantly lower than that of non‐survivors (survivors, 5.63% [2.31–13.8] versus non‐survivors, 27.2% [5.97–41.4]; P = 0.01). In the stratified analysis, the percentage of consolidation/(GGA + consolidation) was significantly associated with 60‐day survival.ConclusionsOur results show that the percentage of consolidation/(GGA + consolidation) on the chest CT scans is an independent prognostic factor for patients with ARDS lacking common risk factors after MPPT.

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The Acute Respiratory Distress Syndrome

Clark

Moss

2016

JAMA

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Hospital Incidence and Outcomes of the Acute Respiratory Distress Syndrome Using the Kigali Modification of the Berlin Definition

Cited by 324 publications

References 33 publications

Acute respiratory distress syndrome

Acute respiratory distress syndrome

High‐dose steroid therapy for acute respiratory distress syndrome lacking common risk factors: predictors of outcome

The Acute Respiratory Distress Syndrome

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