English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background  The current Berlin definition of acute respiratory distress syndrome (ARDS) uses the PaO 2 /FiO 2  (P/F) ratio to classify severity. However, for the same P/F ratio, a patient on a higher positive end-expiratory pressure (PEEP) may have more severe lung injury than one on a lower PEEP.    Objectives  We designed a new formula, the P/FP ratio, incorporating PEEP into the P/F ratio and multiplying with a correction factor of 10 [(PaO 2 *10)/(FiO 2 *PEEP)], to evaluate if it better predicts hospital mortality compared to the P/F ratio post-intubation and to assess the resultant changes in severity classification of ARDS.    Methods  We categorized patients from a dataset of seven ARDS network trials using the thresholds of ≤ 100 (severe), 101–200 (moderate), and 201–300 (mild) for both P/F (mmHg) and P/FP (mmHg/cmH 2 O) ratios and evaluated hospital mortality using areas under the receiver operating characteristic curves (AUC).    Results  Out of 3,442 patients, 1,057 (30.7%) died. The AUC for mortality was higher for the P/FP ratio than the P/F ratio for PEEP levels > 5 cmH 2 O: 0.710 (95% CI 0.691–0.730) versus 0.659 (95% CI 0.637–0.681),  P  < 0.001. Improved AUC was seen with increasing PEEP levels; for PEEP ≥ 18 cmH 2 O: 0.963 (95% CI 0.947–0.978) versus 0.828 (95% CI 0.765–0.891),  P  < 0.001. When the P/FP ratio was used instead of the P/F ratio, 12.5% and 15% of patients with moderate and mild ARDS, respectively, were moved to more severe categories, while 13.9% and 33.6% of patients with severe and moderate ARDS, respectively, were moved to milder categories. The median PEEP and FiO 2  were 14 cmH 2 O and 0.70 for patients reclassified to severe ARDS, and 5 cmH 2 O and 0.40 for patients reclassified to mild ARDS.    Conclusions  The multifactorial P/FP ratio has a greater predictive validity for hospital mortality in ARDS than the P/F ratio. Changes in severity classification with the P/FP ratio reflect both true illness severity and the applied PEEP strategy.   Trial registration : ClinialTrials.gov–NCT03946150.    Supplementary Information  The online version contains supplementary material available at 10.1186/s13613-021-00908-3.

P/FP ratio: incorporation of PEEP into the PaO2/FiO2 ratio for prognostication and classification of acute respiratory distress syndrome