Elisabeth D Riviello1,2, Willy Kiviri3, Theogene Twagirumugabe3, Ariel Mueller4, Valerie M Banner-Goodspeed4, Laurent Officer4, Victor Novack5, Marguerite Mutumwinka6, Daniel S Talmor4, Robert A Fowler7. 1. 1 Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and. 2. 2 Department of Medicine and. 3. 3 Department of Anesthesia, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda. 4. 4 Department of Anesthesia, Critical Care and Pain Management, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts. 5. 5 Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. 6. 6 University Teaching Hospital of Kigali, Kigali, Rwanda; and. 7. 7 Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.
Abstract
RATIONALE: Estimates of the incidence of the acute respiratory distress syndrome (ARDS) in high- and middle-income countries vary from 10.1 to 86.2 per 100,000 person-years in the general population. The epidemiology of ARDS has not been reported for a low-income country at the level of the population, hospital, or intensive care unit (ICU). The Berlin definition may not allow identification of ARDS in resource-constrained settings. OBJECTIVES: To estimate the incidence and outcomes of ARDS at a Rwandan referral hospital using the Kigali modification of the Berlin definition: without requirement for positive end-expiratory pressure, hypoxia cutoff of SpO2/FiO2 less than or equal to 315, and bilateral opacities on lung ultrasound or chest radiograph. METHODS: We screened every adult patient for hypoxia at a public referral hospital in Rwanda for 6 weeks. For every patient with hypoxia, we collected data on demographics and ARDS risk factors, performed lung ultrasonography, and evaluated chest radiography when available. MEASUREMENTS AND MAIN RESULTS: Forty-two (4.0%) of 1,046 hospital admissions met criteria for ARDS. Using various prespecified cutoffs for the SpO2/FiO2 ratio resulted in almost identical hospital incidence values. Median age for patients with ARDS was 37 years, and infection was the most common risk factor (44.1%). Only 30.9% of patients with ARDS were admitted to an ICU, and hospital mortality was 50.0%. Using traditional Berlin criteria, no patients would have met criteria for ARDS. CONCLUSIONS: ARDS seems to be a common and fatal syndrome in a hospital in Rwanda, with few patients admitted to an ICU. The Berlin definition is likely to underestimate the impact of ARDS in low-income countries, where resources to meet the definition requirements are lacking. Although the Kigali modification requires validation before widespread use, we hope this study stimulates further work in refining an ARDS definition that can be consistently used in all settings.
RATIONALE: Estimates of the incidence of the acute respiratory distress syndrome (ARDS) in high- and middle-income countries vary from 10.1 to 86.2 per 100,000 person-years in the general population. The epidemiology of ARDS has not been reported for a low-income country at the level of the population, hospital, or intensive care unit (ICU). The Berlin definition may not allow identification of ARDS in resource-constrained settings. OBJECTIVES: To estimate the incidence and outcomes of ARDS at a Rwandan referral hospital using the Kigali modification of the Berlin definition: without requirement for positive end-expiratory pressure, hypoxia cutoff of SpO2/FiO2 less than or equal to 315, and bilateral opacities on lung ultrasound or chest radiograph. METHODS: We screened every adult patient for hypoxia at a public referral hospital in Rwanda for 6 weeks. For every patient with hypoxia, we collected data on demographics and ARDS risk factors, performed lung ultrasonography, and evaluated chest radiography when available. MEASUREMENTS AND MAIN RESULTS: Forty-two (4.0%) of 1,046 hospital admissions met criteria for ARDS. Using various prespecified cutoffs for the SpO2/FiO2 ratio resulted in almost identical hospital incidence values. Median age for patients with ARDS was 37 years, and infection was the most common risk factor (44.1%). Only 30.9% of patients with ARDS were admitted to an ICU, and hospital mortality was 50.0%. Using traditional Berlin criteria, no patients would have met criteria for ARDS. CONCLUSIONS: ARDS seems to be a common and fatal syndrome in a hospital in Rwanda, with few patients admitted to an ICU. The Berlin definition is likely to underestimate the impact of ARDS in low-income countries, where resources to meet the definition requirements are lacking. Although the Kigali modification requires validation before widespread use, we hope this study stimulates further work in refining an ARDS definition that can be consistently used in all settings.
Authors: Marcus J Schultz; Martin W Dunser; Arjen M Dondorp; Neill K J Adhikari; Shivakumar Iyer; Arthur Kwizera; Yoel Lubell; Alfred Papali; Luigi Pisani; Beth D Riviello; Derek C Angus; Luciano C Azevedo; Tim Baker; Janet V Diaz; Emir Festic; Rashan Haniffa; Randeep Jawa; Shevin T Jacob; Niranjan Kissoon; Rakesh Lodha; Ignacio Martin-Loeches; Ganbold Lundeg; David Misango; Mervyn Mer; Sanjib Mohanty; Srinivas Murthy; Ndidiamaka Musa; Jane Nakibuuka; Ary Serpa Neto; Mai Nguyen Thi Hoang; Binh Nguyen Thien; Rajyabardhan Pattnaik; Jason Phua; Jacobus Preller; Pedro Povoa; Suchitra Ranjit; Daniel Talmor; Jonarthan Thevanayagam; C Louise Thwaites Journal: Intensive Care Med Date: 2017-03-27 Impact factor: 17.440
Authors: Antonio Pesenti; Guido Musch; Daniel Lichtenstein; Francesco Mojoli; Marcelo B P Amato; Gilda Cinnella; Luciano Gattinoni; Michael Quintel Journal: Intensive Care Med Date: 2016-03-31 Impact factor: 17.440
Authors: Fernando Val; Kim Machado; Lisiane Barbosa; Jorge Luis Salinas; André Machado Siqueira; Maria Graças Costa Alecrim; Hernando Del Portillo; Quique Bassat; Wuelton Marcelo Monteiro; Marcus Vinícius Guimarães Lacerda Journal: Am J Trop Med Hyg Date: 2017-07-19 Impact factor: 2.345