The following is a summary of the “Rapidly improving ARDS differs clinically and biologically from persistent ARDS,” published in the April 2024 issue of Critical Care by Toro et al.
Rapidly improving acute respiratory distress syndrome (RIARDS), a subgroup of ARDS with fast oxygenation improvement within 24 hours of ventilation, is being studied to understand its distinct features and inflammatory nature.
Researchers conducted a prospective study to determine the clinical and biological characteristics and link of RIARDS to inflammatory subtypes in ARDS.
They examined data from 215 patients diagnosed with ARDS according to the Berlin criteria (endotracheally intubated) at two sites, a tertiary care center and an urban safety net hospital. Rapidly improving ARDS (RIARDS) was defined based on previous research criteria, firstly PaO2: FiO2 > 300 secondly SpO2: FiO2 > 315 on the day after ARDS diagnosis (day 2) or last unassisted breathing from day 2 to 48 hours later (absence of endotracheal intubation from day 2 to day 4). Plasma biomarkers were assessed on samples collected at study enrollment, and ARDS phenotypes were categorized as previously outlined.
The results showed RIARDS represented 21% of all ARDS cases. Patients with RIARDS exhibited superior clinical outcomes compared to those with persistent ARDS, with a reduced hospital mortality rate (13% vs. 57%; P value < 0.001) and increased ICU-free days (median 24 vs. 0; P value < 0.001). Plasma levels of interleukin-6, interleukin-8, and plasminogen activator inhibitor-1 were notably lower in patients with RIARDS. The hypo-inflammatory phenotype of ARDS was more prevalent among patients with RIARDS (78% vs. 51% in persistent ARDS; P value = 0.001).
Investigators concluded that patients with RIARDS showed lower inflammation markers and a higher prevalence of the hypo-inflammatory phenotype than persistent ARDS, suggesting RIARDS as a distinct entity.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-04883-6