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Limitations of the ...
Limitations of the ARDS criteria during high-flow oxygen or non-invasive ventilation : evidence from critically ill COVID-19 patients
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- Hultström, Michael, 1978- (författare)
- Uppsala universitet,Integrativ Fysiologi,Anestesiologi och intensivvård
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- Hellkvist, Ola (författare)
- Uppsala universitet,Anestesiologi och intensivvård
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- Covaciu, Lucian, 1964- (författare)
- Uppsala universitet,Anestesiologi och intensivvård
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- Fredén, Filip (författare)
- Uppsala universitet,Anestesiologi och intensivvård
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- Frithiof, Robert (författare)
- Uppsala universitet,Anestesiologi och intensivvård
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- Lipcsey, Miklós (författare)
- Uppsala universitet,Hedenstiernalaboratoriet
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- Perchiazzi, Gaetano (författare)
- Uppsala universitet,Hedenstiernalaboratoriet
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- Pellegrini, Mariangela (författare)
- Uppsala universitet,Hedenstiernalaboratoriet
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(creator_code:org_t)
- 2022-03-07
- 2022
- Engelska.
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Ingår i: Critical Care. - : Springer Nature. - 1364-8535 .- 1466-609X. ; 26
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://ccforum.biom...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background: The ratio of partial pressure of arterial oxygen to inspired oxygen fraction (PaO2/FIO2) during invasive mechanical ventilation (MV) is used as criteria to grade the severity of respiratory failure in acute respiratory distress syndrome (ARDS). During the SARS-CoV2 pandemic, the use of PaO2/FIO2 ratio has been increasingly used in non-invasive respiratory support such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The grading of hypoxemia in non-invasively ventilated patients is uncertain. The main hypothesis, investigated in this study, was that the PaO2/FIO2 ratio does not change when switching between MV, NIV and HFNC.Methods: We investigated respiratory function in critically ill patients with COVID-19 included in a single-center prospective observational study of patients admitted to the intensive care unit (ICU) at Uppsala University Hospital in Sweden. In a steady state condition, the PaO2/FIO2 ratio was recorded before and after any change between two of the studied respiratory support techniques (i.e., HFNC, NIV and MV).Results: A total of 148 patients were included in the present analysis. We find that any change in respiratory support from or to HFNC caused a significant change in PaO2/FIO2 ratio. Changes in respiratory support between NIV and MV did not show consistent change in PaO2/FIO2 ratio. In patients classified as mild to moderate ARDS during MV, the change from HFNC to MV showed a variable increase in PaO2/FIO2 ratio ranging between 52 and 140 mmHg (median of 127 mmHg). This made prediction of ARDS severity during MV from the apparent ARDS grade during HFNC impossible.Conclusions: HFNC is associated with lower PaO2/FIO2 ratio than either NIV or MV in the same patient, while NIV and MV provided similar PaO2/FIO2 and thus ARDS grade by Berlin definition. The large variation of PaO2/FIO2 ratio indicates that great caution should be used when estimating ARDS grade as a measure of pulmonary damage during HFNC.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Nyckelord
- Acute respiratory distress syndrome
- Mechanical ventilation
- High-flow oxygen
- Non-invasive ventilation
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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