PaO2/FIO2-Based Stratification Discriminates Treatment Failure in Nonintubated Subjects With ARDS.
Background: The new global definition of nonintubated subjects with ARDS can be applied to patients receiving high-flow nasal cannula (HFNC), but stratification with PaO2/FIO2 has not been validated. We aimed to investigate the differences in oxygenation assessment between HFNC and CPAP for predicti...
| Publicado en: | Respiratory Care Vol. 71; no. 2; pp. 167 - 176 |
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| Autores principales: | , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Feb2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=191254723&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 191254723 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2026 vid: 71 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 191254723 191254723 191254723 10.1177/19433654251376289 191254723 ppf: 167 ppct: 9 formats: tig: atl: PaO2/FIO2-Based Stratification Discriminates Treatment Failure in Nonintubated Subjects With ARDS. aug: au: Sakuraya, Masaaki Nagata, Kazuma Yokoyama, Toshiki Tsugitomi, Ryosuke Nakashima, Harunori Kuraishi, Hiroshi Ohshimo, Shinichiro Mori, Yoshihiro Kagami, Ryogo Tobino, Kazunori Kamo, Tetsuro Kadowaki, Toru Koga, Yasutaka Ogata, Yoshitaka Nishimura, Naoki Kondoh, Yasuhiro Tomii, Keisuke affil: Dr. Sakuraya is affiliated with Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan. sug: subj: Respiratory Distress Syndrome, Acute Therapy Respiration, Artificial Methods Oxygen Therapy Methods Continuous Positive Airway Pressure Methods Treatment Failure Human Male Female Aged Aged, 80 and Over Japan Secondary Analysis Multicenter Studies Randomized Controlled Trials Random Assignment Post Hoc Analysis Anoxemia ROC Curve Intubation, Intratracheal Severity of Illness Indices Kruskal-Wallis Test Fisher's Exact Test Statistical Significance Data Analysis Software Descriptive Statistics Aged: 65+ years Aged, 80 & over Male Female ab: Background: The new global definition of nonintubated subjects with ARDS can be applied to patients receiving high-flow nasal cannula (HFNC), but stratification with PaO2/FIO2 has not been validated. We aimed to investigate the differences in oxygenation assessment between HFNC and CPAP for predicting outcomes. Methods: We performed a post hoc analysis of a multi-center randomized controlled trial conducted in Japan, focusing on oxygenation assessments in subjects receiving HFNC or CPAP. Subjects with PaO2/FIO2 < 300 on CPAP at 5 cm H2O were assigned to receive either HFNC or CPAP. Subjects were stratified into mild (PaO2/FIO2 ≥ 200 but <300), moderate (PaO2/FIO2 ≥ 100 but < 200), or severe (PaO2/FIO2 < 100) hypoxemia categories based on oxygenation levels during CPAP at 5 cm H2O. The primary outcome was treatment failure (intubation or in-hospital death). Discriminative performance for treatment failure was evaluated using the area under the receiver operating characteristic curve (AUROC) for each device. Results: Of the 85 subjects analyzed, 31, 48, and 6 were classified as having mild, moderate, and severe hypoxemia, respectively. Treatment failure occurred more frequently in subjects with moderate and severe hypoxemia than in those with mild hypoxemia (mild 1/31 [3.2%], moderate: 12/48 [25.0%], severe: 3/6 [50.0%], P =.004). Compared with 1 of 38 subjects (2.6%) treated with CPAP, 21 of 47 subjects (44.7%) with HFNC experienced worsened oxygenation even after 30 min of treatment (P <.001). Subjects with HFNC had a lower AUROC of PaO2/FIO2 for treatment failure (0.66, 95% CI 0.54–0.79) than those with CPAP (0.82, 95% CI 0.74–0.90, P =.041). Conclusions: PaO2/FIO2-based stratification may help predict treatment failure in patients with nonintubated subjects with ARDS. However, a thorough oxygenation assessment is necessary because of the variability introduced by different respiratory support devices. CPAP might be superior to HFNC when predicting treatment failure. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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