lung injury of acute onset, within 1 week of an apparent clinical insult and with progression of respiratory symptoms
bilateral opacities on chest imaging (chest radiograph or CT) not explained by other lung pathology (e.g. effusion, lobar/lung collapse, or nodules)
respiratory failure not explained by heart failure or volume overload
decreased PaO2/FiO2 ratio (a decreased PaO2/FiO2 ratio indicates reduced arterial oxygenation from the available inhaled gas):
mild ARDS: 201 – 300 mmHg (≤ 39.9 kPa)
moderate ARDS: 101 – 200 mmHg (≤ 26.6 kPa)
severe ARDS: ≤ 100 mmHg (≤ 13.3 kPa)
NOTE: The Berlin definition requires a minimum positive end expiratory pressure (PEEP) of 5 cmH 2O for consideration of the PaO2/FiO2 ratio. This degree of PEEP may be delivered noninvasively with CPAP to diagnose mild ARDS.
Prevalence of ARDS in COVID-19
It appears that ARDS is something that happens extremely rarely in the ICU setting, according to our data (12,000 pneumonia-related ICU cases) just 2% has one of 20 ICD9 codes that are similar to ARDS, just 0.11% of actual ARDS (ICD9 518.82), and roughly 0.5% among pneumonia patients. [SOURCE: primary analysis]
A study with 99 hospitalized patients with COVID-19 found that " 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure."
Another study with "All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analyzed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardized data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not." found that 29% of patients developed ARDS.
During the 4-year study period, there were 2,501,147 hospitalizations. Applying the ICD-9 ARDS criteria yielded lower and upper limits of 159-205, 439-568, 531-694 and 529-720 cases of ARDS for 1992, 1993, 1994 and 1995, respectively. Normalizing for a population of 5 million yields yearly lower and upper limit rates of 3.2-4.2, 8.8-11.4, 10.6-13.8 and 10.5-14.2 cases of ARDS per 100,000 people. Mortality upper and lower limit rates based upon the same duration, admissions and population were 38-49%, 39-52%, 36-47%, and 36-49%, respectively.
“I have patients in their early 40s and, yeah, I was kind of shocked. I’m seeing people who look relatively healthy with a minimal health history, and they are completely wiped out, like they’ve been hit by a truck. This is knocking out what should be perfectly fit, healthy people. Patients will be on minimal support, on a little bit of oxygen, and then all of a sudden, they go into complete respiratory arrest, shut down and can’t breathe at all.”
Study identifies factors associated with ARDS in COVID-19
Results indicated that more patients who developed ARDS than those who did not presented with dyspnea (59.5% vs. 25.6%; P < .001) and had comorbidities such as hypertension (27.4% vs. 13.7%; P = .02) and diabetes (19% vs. 5.1%; P = .002). Further, patients who developed ARDS were less likely to be treated with antiviral therapy (P = .005) and more likely to be treated with methylprednisolone (P < .001).
Risk factors associated with both ARDS development and progression from ARDS to death included:
older age (HR = 3.26; 95% CI, 2.08-5.11; and HR = 6.17; 95% CI, 3.26-11.67, respectively);
The researchers noted that presentation with a fever of 39°C or higher was also linked to a higher likelihood for development of ARDS (HR = 1.77; 95% CI, 1.11-2.84) but a lower likelihood for death (HR = 0.41; 95% CI, 0.21-0.82). Additionally, risk for death also appeared lower among patients with ARDS who were treated with methylprednisolone (HR = 0.38; 95% CI, 0.2-0.72).
2012 Berlin Definition of ARDS
NOTE: The Berlin definition requires a minimum positive end expiratory pressure (PEEP) of 5 cmH 2O for consideration of the PaO2/FiO2 ratio. This degree of PEEP may be delivered noninvasively with CPAP to diagnose mild ARDS.
Prevalence of ARDS in COVID-19
It appears that ARDS is something that happens extremely rarely in the ICU setting, according to our data (12,000 pneumonia-related ICU cases) just 2% has one of 20 ICD9 codes that are similar to ARDS, just 0.11% of actual ARDS (ICD9 518.82), and roughly 0.5% among pneumonia patients. [SOURCE: primary analysis]
A study with 99 hospitalized patients with COVID-19 found that " 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure."
SOURCE
Another study with "All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analyzed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardized data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not." found that 29% of patients developed ARDS.
SOURCE
During the 4-year study period, there were 2,501,147 hospitalizations. Applying the ICD-9 ARDS criteria yielded lower and upper limits of 159-205, 439-568, 531-694 and 529-720 cases of ARDS for 1992, 1993, 1994 and 1995, respectively. Normalizing for a population of 5 million yields yearly lower and upper limit rates of 3.2-4.2, 8.8-11.4, 10.6-13.8 and 10.5-14.2 cases of ARDS per 100,000 people. Mortality upper and lower limit rates based upon the same duration, admissions and population were 38-49%, 39-52%, 36-47%, and 36-49%, respectively.
SOURCE
Onset of ARDS in COVID-19
SOURCE
Study identifies factors associated with ARDS in COVID-19
Results indicated that more patients who developed ARDS than those who did not presented with dyspnea (59.5% vs. 25.6%; P < .001) and had comorbidities such as hypertension (27.4% vs. 13.7%; P = .02) and diabetes (19% vs. 5.1%; P = .002). Further, patients who developed ARDS were less likely to be treated with antiviral therapy (P = .005) and more likely to be treated with methylprednisolone (P < .001).
Risk factors associated with both ARDS development and progression from ARDS to death included:
The researchers noted that presentation with a fever of 39°C or higher was also linked to a higher likelihood for development of ARDS (HR = 1.77; 95% CI, 1.11-2.84) but a lower likelihood for death (HR = 0.41; 95% CI, 0.21-0.82). Additionally, risk for death also appeared lower among patients with ARDS who were treated with methylprednisolone (HR = 0.38; 95% CI, 0.2-0.72).
SOURCE