Villar, JesúsBlanco, Jesúsdel Campo, RafaelAndaluz-Ojeda, DavidDíaz-Domínguez, Francisco JMuriel, ArturoCórcoles, VirgilioSuárez-Sipmann, FernandoTarancón, ConcepciónGonzález-Higueras, ElenaLópez, JuliaBlanch, LluisPérez-Méndez, LinaFernández, Rosa LidiaKacmarek, Robert2015-05-042015Villar, J., J. Blanco, R. del Campo, D. Andaluz-Ojeda, F. J. Díaz-Domínguez, A. Muriel, V. Córcoles, et al. 2015. “Assessment of PaO2/FiO2 for stratification of patients with moderate and severe acute respiratory distress syndrome.” BMJ Open 5 (3): e006812. doi:10.1136/bmjopen-2014-006812. http://dx.doi.org/10.1136/bmjopen-2014-006812.2044-6055http://nrs.harvard.edu/urn-3:HUL.InstRepos:15034949Objectives: A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) at ARDS onset. Since the proposal did not mandate PaO2/FiO2 calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO2/FiO2 would not provide accurate assessment of lung injury severity. Design: A prospective, multicentre, observational study. Setting: A network of teaching hospitals. Participants: 478 patients with eligible criteria for moderate (100<PaO2/FiO2≤200) and severe (PaO2/FiO2≤100) ARDS and followed until hospital discharge. Interventions We examined physiological and ventilator parameters in association with the PaO2/FiO2 at ARDS onset, after 24 h of usual care and at 24 h under a SVS. At 24 h, patients were reclassified as severe, moderate, mild (200<PaO2/FiO2≤300) ARDS and non-ARDS (PaO2/FiO2>300). Primary and secondary outcomes Group severity and hospital mortality. Results: At ARDS onset, 173 patients had a PaO2/FiO2≤100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO2/FiO2 category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO2/FiO2 and non-standardised PaO2/FiO2 at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). Conclusions: Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. Trial registration numbers NCT00435110 and NCT00736892.en-USRESPIRATORY MEDICINE (see Thoracic Medicine)Journal Article2015-05-0410.1136/bmjopen-2014-006812