Defining the Resolution of Acute Respiratory Distress Syndrome: A Delphi Consensus Study.

OBJECTIVES

There are no established criteria to define the resolution of acute respiratory distress syndrome (ARDS). We aimed to develop an expert consensus definition of ARDS resolution.

DESIGN

Modified Delphi consensus study with three iterative rounds.

SETTING

Electronic surveys.

SUBJECTS: A panel of 19 ARDS experts participated in the Delphi process. Experts were identified using prespecified criteria.

INTERVENTIONS: The Delphi process was conducted over three rounds. Item generation was performed in round 1 with all panelists invited to suggest defining characteristics for resolution of ARDS with corresponding operational definitions, which were then voted on by the panel. Item refinement in rounds 2 and 3. Thresholds for agreement were specified a priori and set at 70%.

MEASUREMENTS AND MAIN

RESULTS

Nineteen panelists submitted complete responses to the first round with 16 panelists contributing to the final definition that met a priori consensus criteria after the third round questionnaire. The panel agreed on the following elements: 1) resolution of hypoxemia, defined as ratio of Pa o2 /F io2 greater than 300 (or ratio of oxygen saturation to F io2 > 315) for more than 24 hours and 2) normalization of level of respiratory support, defined as "if still intubated, this is for primarily nonrespiratory reasons (e.g. altered mental state, ICU-acquired weakness) and ventilatory assistance is minimal (i.e., positive end-expiratory pressure less than or equal to 5 cm H 2 O, and no adjunctive interventions); if maximal respiratory support was continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), then no longer requiring CPAP or NIV; if maximal respiratory support was oxygen via high-flow nasal cannula (HFNC), then no longer requiring HFNC; and if maximal respiratory support was standard oxygen, then longer receiving oxygen."

CONCLUSIONS

A high level of consensus was achieved on criteria defining the resolution of ARDS. Future work is required to explore the epidemiology and performance characteristics of this definition.