Outcomes of World Health Organization–defined Severe Respiratory Distress without Shock in Adults in Sub-Saharan Africa

Sepsis is the leading cause of global mortality and is most often attributed to lower respiratory tract infections and subsequent acute respiratory distress syndrome (ARDS) (1). The greatest burden of sepsis rests on sub-Saharan Africa, where lower respiratory tract infections account for approximately 390,000 adult deaths each year (2). However, patients from sub-Saharan Africa are underrepresented in sepsis and ARDS research (3).

ARDS is difficult to diagnose in low-income countries because it requires often unavailable imaging, mechanical ventilation to set positive end-expiratory pressure and deliver a reliable fraction of inspired oxygen, and arterial blood gases to identify hypoxemia (4). To mitigate this gap, the World Health Organization (WHO) pragmatically defined severe respiratory distress without shock (SRD) in adults as oxygen saturation of less than 90% or a respiratory rate of more than 30 breaths per minute, and a systolic blood pressure over 90 mm Hg in the setting of infection and in the absence of clinical cardiac failure (5). The natural history of SRD has not been fully described; accordingly, we aimed to evaluate the prevalence, characteristics, and outcomes of SRD in hospitalized patients in sub-Saharan Africa.