Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies

Background: Although diffuse alveolar damage (DAD) is considered the typical histological pattern of acute respiratory distress syndrome (ARDS), only half of patients exhibit this morphological hallmark. Patients with DAD may have higher mortality than those without DAD. Therefore, we aimed to ident...

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Autores: Thille, Arnaud W., Peñuelas, Óscar, Lorente Balanza, José Ángel, Fernández Segoviano, P., Rodríguez Barbero, José María, Aramburú González, José Antonio, Panizo, J., Esteban de la Torre, Andrés, Frutos-Vivar, Fernando
Tipo de recurso: artículo
Fecha de publicación:2017
País:España
Institución:Universidad Europea (UEM)
Repositorio:ABACUS. Repositorio de Producción Científica
Idioma:inglés
OAI Identifier:oai:abacus.universidadeuropea.com:11268/9799
Acceso en línea:http://hdl.handle.net/11268/9799
Access Level:acceso abierto
Palabra clave:Síndrome respiratorio agudo grave
Informes de casos
Terapéutica
Aparato respiratorio
Estudio de caso
Tratamiento médico
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spelling Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsiesThille, Arnaud W.Peñuelas, ÓscarLorente Balanza, José ÁngelFernández Segoviano, P.Rodríguez Barbero, José MaríaAramburú González, José AntonioPanizo, J.Esteban de la Torre, AndrésFrutos-Vivar, FernandoSíndrome respiratorio agudo graveInformes de casosTerapéuticaAparato respiratorioEstudio de casoTratamiento médicoBackground: Although diffuse alveolar damage (DAD) is considered the typical histological pattern of acute respiratory distress syndrome (ARDS), only half of patients exhibit this morphological hallmark. Patients with DAD may have higher mortality than those without DAD. Therefore, we aimed to identify the factors associated with DAD in patients with ARDS. Methods: We analyzed autopsy samples of 356 patients who had ARDS at the time of death. DAD was assessed by two pathologists, and ARDS criteria were evaluated by two intensivists. Criteria for severe ARDS included the degree of hypoxemia and the ancillary variables of the current Berlin definition assessed within 48 h before death: radiographic severity, high positive end-expiratory pressure (PEEP) level, and physiological variables (i.e., altered respiratory system compliance and large anatomic dead space). Results: After multivariable analysis, high PEEP levels, physiological variables, and opacities involving only three quadrants on chest radiographs were not associated with DAD. The four markers independently associated with DAD were (1) duration of evolution (OR 3.29 [1.95-5.55] for patients with ARDS ≥ 3 days, p < 0.001), (2) degree of hypoxemia (OR 3.92 [1.48-10.3] for moderate ARDS and 6.18 [2.34-16.3] for severe ARDS, p < 0.01 for both), (3) increased dynamic driving pressure (OR 1.06 [1.04-1.09], p = 0.007), and (4) radiographic severity (OR 2.91 [1.47-5.75] for patients with diffuse opacities involving the four quadrants, p = 0.002). DAD was found in two-thirds of patients with a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen ≤ 100 mmHg and opacities involving the four quadrants. Conclusions: In addition to severe hypoxemia, diffuse opacities involving the four quadrants were a strong marker of DAD.20212021-01-2820172017-01-0120172017-01-01journal articlehttp://purl.org/coar/resource_type/c_6501info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/11268/9799reponame:ABACUS. Repositorio de Producción Científicainstname:Universidad Europea (UEM)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:abacus.universidadeuropea.com:11268/97992026-06-11T12:41:27Z
dc.title.none.fl_str_mv Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
title Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
spellingShingle Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
Thille, Arnaud W.
Síndrome respiratorio agudo grave
Informes de casos
Terapéutica
Aparato respiratorio
Estudio de caso
Tratamiento médico
title_short Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
title_full Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
title_fullStr Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
title_full_unstemmed Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
title_sort Predictors of diffuse alveolar damage in patients with acute respiratory distress syndrome: A retrospective analysis of clinical autopsies
dc.creator.none.fl_str_mv Thille, Arnaud W.
Peñuelas, Óscar
Lorente Balanza, José Ángel
Fernández Segoviano, P.
Rodríguez Barbero, José María
Aramburú González, José Antonio
Panizo, J.
Esteban de la Torre, Andrés
Frutos-Vivar, Fernando
author Thille, Arnaud W.
author_facet Thille, Arnaud W.
Peñuelas, Óscar
Lorente Balanza, José Ángel
Fernández Segoviano, P.
Rodríguez Barbero, José María
Aramburú González, José Antonio
Panizo, J.
Esteban de la Torre, Andrés
Frutos-Vivar, Fernando
author_role author
author2 Peñuelas, Óscar
Lorente Balanza, José Ángel
Fernández Segoviano, P.
Rodríguez Barbero, José María
Aramburú González, José Antonio
Panizo, J.
Esteban de la Torre, Andrés
Frutos-Vivar, Fernando
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Síndrome respiratorio agudo grave
Informes de casos
Terapéutica
Aparato respiratorio
Estudio de caso
Tratamiento médico
topic Síndrome respiratorio agudo grave
Informes de casos
Terapéutica
Aparato respiratorio
Estudio de caso
Tratamiento médico
description Background: Although diffuse alveolar damage (DAD) is considered the typical histological pattern of acute respiratory distress syndrome (ARDS), only half of patients exhibit this morphological hallmark. Patients with DAD may have higher mortality than those without DAD. Therefore, we aimed to identify the factors associated with DAD in patients with ARDS. Methods: We analyzed autopsy samples of 356 patients who had ARDS at the time of death. DAD was assessed by two pathologists, and ARDS criteria were evaluated by two intensivists. Criteria for severe ARDS included the degree of hypoxemia and the ancillary variables of the current Berlin definition assessed within 48 h before death: radiographic severity, high positive end-expiratory pressure (PEEP) level, and physiological variables (i.e., altered respiratory system compliance and large anatomic dead space). Results: After multivariable analysis, high PEEP levels, physiological variables, and opacities involving only three quadrants on chest radiographs were not associated with DAD. The four markers independently associated with DAD were (1) duration of evolution (OR 3.29 [1.95-5.55] for patients with ARDS ≥ 3 days, p < 0.001), (2) degree of hypoxemia (OR 3.92 [1.48-10.3] for moderate ARDS and 6.18 [2.34-16.3] for severe ARDS, p < 0.01 for both), (3) increased dynamic driving pressure (OR 1.06 [1.04-1.09], p = 0.007), and (4) radiographic severity (OR 2.91 [1.47-5.75] for patients with diffuse opacities involving the four quadrants, p = 0.002). DAD was found in two-thirds of patients with a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen ≤ 100 mmHg and opacities involving the four quadrants. Conclusions: In addition to severe hypoxemia, diffuse opacities involving the four quadrants were a strong marker of DAD.
publishDate 2017
dc.date.none.fl_str_mv 2017
2017-01-01
2017
2017-01-01
2021
2021-01-28
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/11268/9799
url http://hdl.handle.net/11268/9799
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:ABACUS. Repositorio de Producción Científica
instname:Universidad Europea (UEM)
instname_str Universidad Europea (UEM)
reponame_str ABACUS. Repositorio de Producción Científica
collection ABACUS. Repositorio de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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