Title

HospitalIncidenceandOutcomesoftheAcuteRespiratoryDistress SyndromeUsingtheKigaliModificationoftheBerlinDefinition

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

American Journal of Respiratory and Critical Care Medicine

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