Prognostic value of the novel P/FPE index to classify ARDS severity: A cohort study / Valor pronóstico del nuevo índice P/FPE para clasificar la severidad del SDRA: Estudio de cohorte

Objective To evaluate the impact of the novel P/FPE index to classify ARDS severity on mortality of patients with ARDS. Design A retrospective cohort study. Setting Twelve-bed medical and surgical intensive care unit from January 2018 to December 2020. Patients A total of 217 ARDS patients managed with invasive mechanical ventilation >48h. Interventions None. Variables ARDS severity on day 1 and day 3 was measured based on PaO2/FiO2 ratio and P/FPE index [PaO2/(FiO2×PEEP)]. Primary outcome was the hospital mortality. Results Hospital mortality rate was 59.9%. Relative to PaO2/FiO2 ratio, 31.8% of patients on day 1 and 77.0% on day 3 were reclassified into a different category of ARDS severity by P/FPE index. The level of PEEP was lower by P/FPE index-based ARDS severity classification than by using PaO2/FiO2 ratio. The performance for predicting mortality of P/FPE index was superior to PaO2/FiO2 ratio in term of AROC (day 1: 0.72 vs. 0.62; day 3: 0.87 vs. 0.68) and CORR (day 1: 0.370 vs. 0.213; day 3: 0.634 vs. 0.301). P/FPE index improved prediction of risk of death compared to PaO2/FiO2 ratio as showed by the qNRI (day 1: 72.0%, p<0.0001; day 3: 132.4%, p<0.0001) and IDI (day 1: 0.09, p<0.0001; day 3: 0.31, p<0.0001). Conclusions Assessment of ARDS severity based on P/FPE index seems better than PaO2/FiO2 ratio for predicting mortality. The value of P/FPE index for clinical decision-making requires confirmation by randomized controlled trials (AU)

Objetivo Evaluar el impacto del índice P/FPE para clasificar la severidad del SDRA y su relación con la mortalidad. Diseño Estudio de cohorte retrospectivo. Contexto Unidad de cuidados intensivos polivalentes de 12 camas desde enero de 2018 hasta diciembre de 2020. Pacientes Se estudió a 217 pacientes con SDRA con ventilación invasiva>48 horas. Intervenciones Ninguna. Variables La severidad del SDRA se evaluó el primer y el tercer día, según el índice PaO2/FiO2 y el índice P/FPE (PaO2/[FiO2×PEEP]). El desenlace primario evaluado fue la mortalidad hospitalaria. Resultados La mortalidad hospitalaria fue 59,9%. Con relación al índice PaO2/FiO2, el 31,8% de los pacientes el día 1 y el 77,0% el día 3 fue reclasificado en categorías diferentes de severidad del SDRA mediante el índice P/FPE. El nivel de PEEP fue más bajo con el uso del índice P/FPE que con el PaO2/FiO2. La predicción de la mortalidad fue superior con el índice P/FPE que con PaO2/FiO2, en términos de AROC (día 1: 0,72 vs. 0,62; día 3: 0,87 vs. 0,68) y CORR (día 1: 0,370 vs. 0,213; día 3: 0,634 vs. 0,301). El índice P/FPE mejoró la predicción del riesgo de muerte comparado con el PaO2/FiO2, como demuestra el qNRI (día 1: 72,0%, p<0,0001; día 3: 132,4%, p<0,0001) y el IDI (día 1: 0,09, p<0,0001; día 3: 0,31, p<0,0001). Conclusiones La evaluación de severidad del SDRA mediante el índice P/FPE parece ser mejor que la del índice PaO2/FiO2 para predecir la mortalidad. El valor del P/FPE para la toma de decisiones clínicas requiere confirmación mediante ensayos clínicos (AU)

Middle East respiratory syndrome coronavirus (MERS-CoV) infection: chest CT findings.

OBJECTIVE: The purpose of this study was to describe the chest CT findings in seven patients with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. CONCLUSION: The most common CT finding in hospitalized patients with MERS-CoV infection is that of bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. The subpleural and peribronchovascular predilection of the abnormalities is suggestive of an organizing pneumonia pattern.

[Acute respiratory distress syndrome in pediatric cardiosurgery].

The prognosis in acute respiratory distress syndrome (ARDS) is poor; its mortality is generally 40-60%. The mortality in patients with ARDS is more commonly associated with the sequels of sepsis and multiple organ dysfunction than with respiratory failure although the latest papers on protective ventilation suggest that death in these patients directly results from lung lesion in a number of cases. There have been encouraging data on the reduced mortality rates due to acute lung lesion/ARDS in the past decade. The development and introduction of new technologies of respiratory support, the emergence of new effective treatments for sepsis, and the improvement of general maintenance therapy in patients with ARDS may be a possible explanation for such changes for the best.

[Chest X-ray features of severe acute respiratory syndrome and clinical staging].

OBJECTIVE: To establish a clinical staging system for patients with severe acute respiratory syndrome (SARS) based on clinical feature, laboratory tests as well as dynamic changes of chest X-ray images. METHOD: Dynamic changes of chest X-ray images and laboratory tests in 45 SARS patients managed from March to May, 2003 were analyzed. RESULTS: (1) Chest X-ray image: among 45 cases, 23 were common type: the time to appearance of unilateral patched shadow of the lung were 2 to 5 (2.9 +/- 1.0) days. The time to appearance of bilateral patched shadow of the lungs were 2 to 12 (6.9 +/- 2.5) days. The time to appearance of ground glass or consolidation in the lung were 6 to 19 (11.0 +/- 2.0) days. The time to the beginning of absorption of X-ray changes were 10 to 21 (15.0 +/- 4.1) days. The time for chest X-ray image to be absorbed completely were 18 to 46 (25.9 +/- 7.2) days. Twenty-two patients were severe type, in which the time to the appearance of ground glass of the lung were (9.0 +/- 3.2) days, with no significant difference when compared with common type (P < 0.05). However, the time to the beginning of absorption and complete absorption were (19.0 +/- 4.6) days (P = 0.009) and (36.0 +/- 8.1) days (P = 0.001), respectively. Noticeably, the time to pan-consolidation of the lung were less than 7 days in 7 fatal cases. (2) Laboratory tests: decrease in the number of lymphocytes and T lymphocyte subset were seen in the early stage. While the account recovered in 10 to 14 days of disease course in the 38 patients who survived, there was no recovery in 7 patients who died. CONCLUSIONS: SARS can be divided into five stages: incubation period 2 to 10 days, prodromal period 1 to 3 days, progressive period 4 to 7 days, advanced period 8 to 15 days were, convalescent period 16 to 24 days. The appearance of pan-consolidation in the lung in less than 7 days and/or unable to recover the number of lymphocytes and T lymphocyte subset will be associated with poor prognosis.