OBJECTIVE: We examined whether PEEP during the first hours of ARDS can induce such a change in oxygenation that could mask fulfillment of the AECC criteria of a PaO(2)/FIO(2) </= 200 essential for ARDS diagnosis. DESIGN AND SETTING: Observational, prospective cohort in two medical-surgical ICU in teaching hospitals. PATIENTS: 48 consecutive patients who met AECC criteria of ARDS on 0 PEEP (ZEEP) at the moment of diagnosis. MEASUREMENTS AND RESULTS: PaO(2)/FIO(2) and lung mechanics were recorded on admission (0 h) to the ICU on ZEEP, and after 6, 12, and 24 h on PEEP levels selected by attending physicians. Lung Injury Score (LIS) was calculated at 0 and 24 h. PaO(2)/FIO(2) rose significantly from 121+/-45 on ZEEP at 0 h, to 234+/-85 on PEEP of 12.8+/-3.7 cmH(2)O after 24 h. LIS did not change significantly (2.34+/-0.53 vs. 2.42+/-0.62). These variables behaved similarly in pulmonary and extrapulmonary ARDS, and in survivors and nonsurvivors. After 24 h only 18 patients (38%) still had a PaO(2)/FIO(2) of 200 or lower. Their mortality was similar to that in the remaining patients (61% vs. 53%). CONCLUSIONS: The use of PEEP improved oxygenation such that one-half of patients after 6 h, and most after 24 h did not fulfill AECC hypoxemia criteria of ARDS. However, LIS remained stable in the overall series. These results suggest that PEEP level should be taken into consideration for ARDS diagnosis.
OBJECTIVE: We examined whether PEEP during the first hours of ARDS can induce such a change in oxygenation that could mask fulfillment of the AECC criteria of a PaO(2)/FIO(2) </= 200 essential for ARDS diagnosis. DESIGN AND SETTING: Observational, prospective cohort in two medical-surgical ICU in teaching hospitals. PATIENTS: 48 consecutive patients who met AECC criteria of ARDS on 0 PEEP (ZEEP) at the moment of diagnosis. MEASUREMENTS AND RESULTS: PaO(2)/FIO(2) and lung mechanics were recorded on admission (0 h) to the ICU on ZEEP, and after 6, 12, and 24 h on PEEP levels selected by attending physicians. Lung Injury Score (LIS) was calculated at 0 and 24 h. PaO(2)/FIO(2) rose significantly from 121+/-45 on ZEEP at 0 h, to 234+/-85 on PEEP of 12.8+/-3.7 cmH(2)O after 24 h. LIS did not change significantly (2.34+/-0.53 vs. 2.42+/-0.62). These variables behaved similarly in pulmonary and extrapulmonary ARDS, and in survivors and nonsurvivors. After 24 h only 18 patients (38%) still had a PaO(2)/FIO(2) of 200 or lower. Their mortality was similar to that in the remaining patients (61% vs. 53%). CONCLUSIONS: The use of PEEP improved oxygenation such that one-half of patients after 6 h, and most after 24 h did not fulfill AECC hypoxemia criteria of ARDS. However, LIS remained stable in the overall series. These results suggest that PEEP level should be taken into consideration for ARDS diagnosis.
Authors: M O Meade; G H Guyatt; R J Cook; R Groll; J R Kachura; M Wigg; D J Cook; A S Slutsky; T E Stewart Journal: Am J Respir Crit Care Med Date: 2001-02 Impact factor: 21.405
Authors: G R Bernard; A Artigas; K L Brigham; J Carlet; K Falke; L Hudson; M Lamy; J R Legall; A Morris; R Spragg Journal: Am J Respir Crit Care Med Date: 1994-03 Impact factor: 21.405
Authors: T E Kloot; L Blanch; A Melynne Youngblood; C Weinert; A B Adams; J J Marini; R S Shapiro; A Nahum Journal: Am J Respir Crit Care Med Date: 2000-05 Impact factor: 21.405
Authors: P Krafft; P Fridrich; T Pernerstorfer; R D Fitzgerald; D Koc; B Schneider; A F Hammerle; H Steltzer Journal: Intensive Care Med Date: 1996-06 Impact factor: 17.440
Authors: M Monchi; F Bellenfant; A Cariou; L M Joly; D Thebert; I Laurent; J F Dhainaut; F Brunet Journal: Am J Respir Crit Care Med Date: 1998-10 Impact factor: 21.405
Authors: Edward Abraham; Peter Andrews; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Geoffrey Dobb; Jean-Yves Fagon; Johan Groeneveld; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Michael Pinsky; Peter Radermacher; Marco Ranieri; Christian Richard; Robert Tasker; Benoît Vallet Journal: Intensive Care Med Date: 2004-05-15 Impact factor: 17.440
Authors: Giora Netzer; David W Dowdy; Thelma Harrington; Satish Chandolu; Victor D Dinglas; Nirav G Shah; Elizabeth Colantuoni; Pedro A Mendez-Tellez; Carl Shanholtz; Jeffrey D Hasday; Dale M Needham Journal: Ann Am Thorac Soc Date: 2013-12
Authors: Cyril Charron; Koceila Bouferrache; Vincent Caille; Samuel Castro; Philippe Aegerter; Bernard Page; François Jardin; Antoine Vieillard-Baron Journal: Intensive Care Med Date: 2011-03-02 Impact factor: 17.440
Authors: Dharmvir S Jaswal; Janice M Leung; Junfeng Sun; Xizhong Cui; Yan Li; Steven Kern; Judith Welsh; Charles Natanson; Peter Q Eichacker Journal: Crit Care Med Date: 2014-10 Impact factor: 7.598
Authors: Thomas Namdar; Peter Leonard Stollwerck; Felix Hagen Stang; Karl-Friedrich Klotz; Thomas Lange; Peter Mailänder; Frank Siemers Journal: Ger Med Sci Date: 2010-06-07
Authors: Rogier M Determann; Julian L Millo; Sam Waddy; Rene Lutter; Chris S Garrard; Marcus J Schultz Journal: BMC Pulm Med Date: 2009-12-03 Impact factor: 3.317