La mortalidad fue mayor en el grupo con SDRA Citas 1. Gac Med Mex. Pediatric Acute Lung Injury Epidemiology and Natural History study: incidence and outcome of the acute respiratory distress syndrome in children. Crit Care Med. Intensive Care Med.
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We read with great interest the paper by Riviello et al. The study by Riviello et al. In keeping with this contention, recent evidence 2 underscores that the global impact of ARDS itself is difficult to estimate due to demographic, economic and health care system differences among developed and developing countries. Moreover, risk factors for ARDS may differ between high and low income countries 3.
While the higher percentage of traumatic and infectious disease in resource-poor settings may increase ARDS incidence, the lack of critical care resource may signify that critically ill patients die before the development of ARDS 4. Finally, in a month prospective, observational study, enrolling 7, patients in 14 ICUs in Brazil 9 , 1.
In this context, the Kigali modification of the Berlin definition may help to overcome these difficulties by adapting the ARDS definition to the existing health care system in the developing world. This investigation, which was an international, multicenter, prospective cohort study, was undertaken to assess the ICU epidemiology and outcomes from ARDS as well as to evaluate clinical recognition of the disease and its management.
One of the strengths of this study was that the patients were enrolled from all over the world, in the same period of 4 consecutive winter weeks February—March in the Northern hemisphere and June—August in the Southern hemisphere.
The overall incidence of ARDS was Geographic variations were confirmed, with Europe having an incidence of 0. Taking into account that the Berlin definition was adopted for all cases and the low availability of ICU beds in the developing world, it is conceivable to suppose that ARDS was underestimated in low-income countries.
However, the innovative and challenging investigation by Riviello et al. When the Berlin definition was elaborated, three criteria were fulfilled: feasibility, reliability and validity The term reliability indicates observer agreement on case identification but this criterion has still to be assessed with Kigali definition.
Moreover, though each of the three pieces of the modification has been validated previously, the whole modification has not. Their findings come from a small single center in one country in sub-Saharan Africa in one rainy season and indicate an hospital screening, while most previous studies screened intubated ICU patients. Thus, its validation should be encouraged and further studies in other resource-constrained settings should be performed in order to assess reliability and validity of Kigali modification.
The aim of a disease definition has the same clinical importance all over the world, that is to facilitate case recognition and better match treatment options to severity.
Conflicts of Interest: The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List J Thorac Dis v. J Thorac Dis. Chiara Lazzeri 1 and Adriano Peris 2. Chiara Lazzeri 1 Find articles by Chiara Lazzeri. Adriano Peris 2 Find articles by Adriano Peris.
Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to : Chiara Lazzeri, MD. Email: ti. Received Mar 9; Accepted Mar Copyright Journal of Thoracic Disease. All rights reserved. Acknowledgements None. References 1. Current incidence and outcome of the acute respiratory distress syndrome. Curr Opin Crit Care ; 22 Acute respiratory distress syndrome in the global context. Glob Heart ; 9 Critical care and the global burden of critical illness in adults.
Lancet ; Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Acute respiratory distress syndrome: the Berlin Definition.
JAMA ; Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care ; 17 :R Incidence, clinical course, and outcome in patients with acute respiratory distress syndrome. Crit Care Med ; 30 Crit Care Med ; 42 Eight-year trend of acute respiratory distress syndrome: a population-based study in Olmsted County, Minnesota.
The Kigali modification of the berlin definition: a new epidemiological tool for ARDS?
Although that definition is simple to apply in the clinical setting, it has been challenged over the years in several studies since the assessment of the oxygenation defect does not require standardized ventilatory support. We were the first to propose new guidelines, based on a specific, standard method of evaluating oxygenation status, a proposal that was later advocated by others. To address the limitations of the AECC definition, a modified ARDS definition has been proposed by a task force panel of experts, referred to as the Berlin Defintion, using a terminology similar to that we previously proposed. However, that proposal has several methodological flaws. Since all ARDS patients start off with terrible oxygenation, the Berlin Definition offers no room for stratifying and identifyng true ARDS patients since there is no further re-evaluation of the hypoxemia under standard ventilator setting in a specific time period. Long live the King! The original phrase was translated from the French Le Roi est mort, vive le Roi!
2019, Número 5
Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. Recovery and outcomes after the acute respiratory distress syndrome ARDS in patients and their family caregivers. Intensive Care Med. Acute respiratory distress syndrome, seminar. Epidemiology and outcome of acute lung injury in European intensive care units. One-year mortality and predictors of death among hospital survivors of acute respiratory distress syndrome.
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