Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study / Byron Enrique Piñeres Olave  

Público ISBD Título : Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study Tipo de documento : documento electrónico Autores : Byron Enrique Piñeres Olave, Fecha de publicación : 2020 Títulos uniformes : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : ARDS  Chest radiograph  Diagnostic accuracy  Inter-rater variability  Outcome Resumen : Purpose: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Mención de responsabilidad : Yolanda M López-Fernández, Lincoln S Smith, Joseph G Kohne, Jason P Weinman, Vicent Modesto-Alapont, Susana B Reyes-Dominguez, Alberto Medina, Byron E Piñeres-Olave, Natalie Mahieu, Margaret J Klein, Heidi R Flori, Philippe Jouvet, Robinder G Khemani, the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V3 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Intensive Care Med. 2020 Jul;46(7):1382-1393. DOI (Digital Object Identifier) : 10.1007/s00134-020-06074-7 PMID : 32451578 En línea : https://link.springer.com/article/10.1007/s00134-020-06074-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5099 Prognostic relevance and inter-observer reliability of chest-imaging in pediatric ARDS: a pediatric acute respiratory distress incidence and epidemiology (PARDIE) study [documento electrónico] / Byron Enrique Piñeres Olave,  . - 2020. Obra : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : ARDS  Chest radiograph  Diagnostic accuracy  Inter-rater variability  Outcome Resumen : Purpose: Definitions of acute respiratory distress syndrome (ARDS) include radiographic criteria, but there are concerns about reliability and prognostic relevance. This study aimed to evaluate the independent relationship between chest imaging and mortality and examine the inter-rater variability of interpretations of chest radiographs (CXR) in pediatric ARDS (PARDS). Methods: Prospective, international observational study in children meeting Pediatric Acute Lung Injury Consensus Conference (PALICC) criteria for PARDS, which requires new infiltrate(s) consistent with pulmonary parenchymal disease, without mandating bilateral infiltrates. Mortality analysis focused on the entire cohort, whereas inter-observer variability used a subset of patients with blinded, simultaneous interpretation of CXRs by intensivists and radiologists. Results: Bilateral infiltrates and four quadrants of alveolar consolidation were associated with mortality on a univariable basis, using CXRs from 708 patients with PARDS. For patients on either invasive (IMV) or non-invasive ventilation (NIV) with PaO2/FiO2 (PF) ratios (or SpO2/FiO2 (SF) ratio equivalent) > 100, neither bilateral infiltrates (OR 1.3 (95% CI 0.68, 2.5), p = 0.43), nor 4 quadrants of alveolar consolidation (OR 1.6 (0.85, 3), p = 0.14) were associated with mortality. For patients with PF ≤ 100, bilateral infiltrates (OR 3.6 (1.4, 9.4), p = 0.01) and four quadrants of consolidation (OR 2.0 (1.14, 3.5), p = 0.02) were associated with higher mortality. A subset of 702 CXRs from 233 patients had simultaneous interpretations. Interobserver agreement for bilateral infiltrates and quadrants was “slight” (kappa 0.31 and 0.33). Subgroup analysis showed agreement did not differ when stratified by PARDS severity but was slightly higher for children with chronic respiratory support (kappa 0.62), NIV at PARDS diagnosis (kappa 0.53), age > 10 years (kappa 0.43) and fluid balance > 40 ml/kg (kappa 0.48). Conclusion: Bilateral infiltrates and quadrants of alveolar consolidation are associated with mortality only for those with PF ratio ≤ 100, although there is high- inter-rater variability in these chest-x ray parameters. Mención de responsabilidad : Yolanda M López-Fernández, Lincoln S Smith, Joseph G Kohne, Jason P Weinman, Vicent Modesto-Alapont, Susana B Reyes-Dominguez, Alberto Medina, Byron E Piñeres-Olave, Natalie Mahieu, Margaret J Klein, Heidi R Flori, Philippe Jouvet, Robinder G Khemani, the Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology (PARDIE) V3 Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network Referencia : Intensive Care Med. 2020 Jul;46(7):1382-1393. DOI (Digital Object Identifier) : 10.1007/s00134-020-06074-7 PMID : 32451578 En línea : https://link.springer.com/article/10.1007/s00134-020-06074-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5099

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Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study / Diego Alejandro Muñoz Rincón  

Público ISBD Título : Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study Tipo de documento : documento electrónico Autores : Diego Alejandro Muñoz Rincón, Fecha de publicación : 2015 Títulos uniformes : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : Adult respiratory distress syndrome  diffuse alveolar damage  subphenotype  histology  autopsy  hyaline membranes Resumen : Objective: To demonstrate that among patients with acute respiratory distress syndrome (ARDS), the presence of diffuse alveolar damage (DAD) at histological examination, as compared to its absence, defines a specific subphenotype. Methods: We studied 149 patients who died in our ICU with the clinical diagnosis of ARDS according to the Berlin Definition (BD) and who had autopsy examination. We compared the change over time of different clinical variables in patients with (n = 49) and without (n = 100) DAD. A predictive model for the presence of DAD was developed and validated in an independent cohort of 57 patients with ARDS and postmortem examination (21 of them with DAD). Results: Patients with DAD, as compared to patients without DAD, had a lower PaO2/FiO2 ratio and dynamic respiratory system compliance, and a higher SOFA score and INR, and were more likely to die of hypoxemia and less likely to die of shock. In multivariate analysis, variables associated with DAD [odds ratio, 95 % confidence interval (CI)] were PaO2/FiO2 ratio [0.988 (0.981–0.995)], dynamic respiratory system compliance [0.937 (0.892–0.984)] and age [0.972 (0.946–0.999)]. Areas under the ROC curve (95 % CI) for the classification of DAD using the regression model or the BD were, respectively, 0.74 (0.65–0.82) and 0.64 (0.55–0.72) (p = 0.03). In the validation cohort, the areas under the ROC curve for the diagnosis of DAD were 0.73 (0.56–0.90) and 0.67 (0.54–0.81) for the regression model and the BD, respectively. Conclusions: The presence of DAD appears to define a specific subphenotype in patients with ARDS. Targeting patients with DAD within the population of patients with the clinical diagnosis of ARDS might be appropriate to find effective therapies for this condition. Mención de responsabilidad : José A Lorente, Pablo Cardinal-Fernández, Diego Muñoz, Fernando Frutos-Vivar, Arnaud W Thille, Carlos Jaramillo, Aida Ballén-Barragán, José M Rodríguez, Oscar Peñuelas, Guillermo Ortiz, José Blanco, Bruno Valle Pinheiro, Nicolás Nin, María del Carmen Marin, Andrés Esteban, Taylor B Thompson Referencia : Intensive Care Med. 2015 Nov;41(11):1921-30. DOI (Digital Object Identifier) : 10.1007/s00134-015-4046-0 PMID : 26385863 En línea : https://link.springer.com/article/10.1007%2Fs00134-015-4046-0 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3937 Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study [documento electrónico] / Diego Alejandro Muñoz Rincón,  . - 2015. Obra : Intensive Care Medicine Idioma : Inglés (eng) Palabras clave : Adult respiratory distress syndrome  diffuse alveolar damage  subphenotype  histology  autopsy  hyaline membranes Resumen : Objective: To demonstrate that among patients with acute respiratory distress syndrome (ARDS), the presence of diffuse alveolar damage (DAD) at histological examination, as compared to its absence, defines a specific subphenotype. Methods: We studied 149 patients who died in our ICU with the clinical diagnosis of ARDS according to the Berlin Definition (BD) and who had autopsy examination. We compared the change over time of different clinical variables in patients with (n = 49) and without (n = 100) DAD. A predictive model for the presence of DAD was developed and validated in an independent cohort of 57 patients with ARDS and postmortem examination (21 of them with DAD). Results: Patients with DAD, as compared to patients without DAD, had a lower PaO2/FiO2 ratio and dynamic respiratory system compliance, and a higher SOFA score and INR, and were more likely to die of hypoxemia and less likely to die of shock. In multivariate analysis, variables associated with DAD [odds ratio, 95 % confidence interval (CI)] were PaO2/FiO2 ratio [0.988 (0.981–0.995)], dynamic respiratory system compliance [0.937 (0.892–0.984)] and age [0.972 (0.946–0.999)]. Areas under the ROC curve (95 % CI) for the classification of DAD using the regression model or the BD were, respectively, 0.74 (0.65–0.82) and 0.64 (0.55–0.72) (p = 0.03). In the validation cohort, the areas under the ROC curve for the diagnosis of DAD were 0.73 (0.56–0.90) and 0.67 (0.54–0.81) for the regression model and the BD, respectively. Conclusions: The presence of DAD appears to define a specific subphenotype in patients with ARDS. Targeting patients with DAD within the population of patients with the clinical diagnosis of ARDS might be appropriate to find effective therapies for this condition. Mención de responsabilidad : José A Lorente, Pablo Cardinal-Fernández, Diego Muñoz, Fernando Frutos-Vivar, Arnaud W Thille, Carlos Jaramillo, Aida Ballén-Barragán, José M Rodríguez, Oscar Peñuelas, Guillermo Ortiz, José Blanco, Bruno Valle Pinheiro, Nicolás Nin, María del Carmen Marin, Andrés Esteban, Taylor B Thompson Referencia : Intensive Care Med. 2015 Nov;41(11):1921-30. DOI (Digital Object Identifier) : 10.1007/s00134-015-4046-0 PMID : 26385863 En línea : https://link.springer.com/article/10.1007%2Fs00134-015-4046-0 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3937

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