HospitalIncidenceandOutcomesoftheAcuteRespiratoryDistress SyndromeUsingtheKigaliModificationoftheBerlinDefinition

Authors

Elisabeth D. Riviello, Division of Pulmonary,Critical Care and Sleep Medicine
Willy Kiviri, Aga Khan UniversityFollow
Theogene Twagirumugabe, University of Rwanda,College of Medicine and Health Sciences,Kigali,Rwanda
Ariel Mueller, Harvard Medical School, Boston,Massachusetts
Valerie M. Banner-Goodspeed, Harvard Medical School, Boston,Massachusetts
Laurent Officer, Harvard Medical School, Boston,Massachusetts
Victor Novack, Soroka University Medical Center
Marguerite Mutumwinka, University Teaching Hospital of Kigali,Kigali,Rwanda
Daniel S. Talmor, Harvard Medical School, Boston,Massachusetts
Robert A. Fowler, University of Toronto,Toronto,Ontario,Canada

Document Type

Article

Department

Medical College (East Africa)

Abstract

Rationale:

Estimatesoftheincidenceoftheacuterespiratory distresssyndrome(ARDS)inhigh-andmiddle-incomecountries varyfrom10.1to86.2per100,000person-yearsinthegeneral population.TheepidemiologyofARDShasnotbeenreportedfor alow-incomecountryatthelevelofthepopulation,hospital,or intensivecareunit(ICU).TheBerlindefinitionmaynotallow identificationofARDSinresource-constrainedsettings.

Objectives:

ToestimatetheincidenceandoutcomesofARDS ataRwandanreferralhospitalusingtheKigalimodificationof theBerlindefinition:withoutrequirementforpositiveendexpiratorypressure,hypoxiacutoffofSpO2 /FIO2 lessthanor equalto315,andbilateralopacitiesonlungultrasoundorchest radiograph.

Methods:

Wescreenedeveryadultpatientforhypoxiaatapublic referralhospitalinRwandafor6weeks.Foreverypatientwith hypoxia,wecollecteddataondemographicsandARDSriskfactors, performedlungultrasonography,andevaluatedchestradiography whenavailable.

MeasurementsandMainResults:

Forty-two(4.0%)of 1,046hospitaladmissionsmetcriteriaforARDS.Using variousprespecifiedcutoffsfortheSpO2 /FIO2 ratioresultedin almostidenticalhospitalincidencevalues.Medianagefor patientswithARDSwas37years,andinfectionwasthemost commonriskfactor(44.1%).Only30.9%ofpatientswithARDS wereadmittedtoanICU,andhospitalmortalitywas50.0%. UsingtraditionalBerlincriteria,nopatientswouldhavemet criteriaforARDS.

Conclusions:

ARDSseemstobeacommonandfatal syndromeinahospitalinRwanda,withfewpatientsadmittedto anICU.TheBerlindefinitionislikelytounderestimatethe impactofARDSinlow-incomecountries,whereresourcesto meetthedefinitionrequirementsarelacking.Althoughthe Kigalimodificationrequiresvalidationbeforewidespreaduse, wehopethisstudystimulatesfurtherworkinrefininganARDS definitionthatcanbeconsistentlyusedinallsettings.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

American Journal of Respiratory and Critical Care Medicine

Recommended Citation

Riviello, E. D., Kiviri, W., Twagirumugabe, T., Mueller, A., Banner-Goodspeed, V. M., Officer, L., ... & Fowler, R. A. (2016). Hospital incidence and outcomes of the acute respiratory distress syndrome using the Kigali modification of the Berlin definition. American journal of respiratory and critical care medicine, 193(1), 52-59.