Journal article
Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study
Intensive care medicine, Vol.42(12), pp.1865-1876
12/01/2016
DOI: 10.1007/s00134-016-4571-5
PMID: 27757516
Abstract
Purpose: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality.
Methods: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1-2 who received invasive mechanical ventilation.
Results: 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO2/FiO(2) ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores.
Conclusions: Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS.
Details
- Title: Subtitle
- Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study
- Creators
- John G. Laffey - University of TorontoGiacomo Bellani - University of Milano-BicoccaTai Pham - Bicêtre HospitalEddy Fan - University of TorontoFabiana Madotto - University of Milano-BicoccaEdnan K. Bajwa - Massachusetts General HospitalLaurent Brochard - University of TorontoKevin Clarkson - Ollscoil na Gaillimhe – University of GalwayAndres Esteban - Hospital Universitario de GetafeLuciano Gattinoni - Universitätsmedizin GöttingenFrank van Haren - Australian National UniversityLeo M. Heunks - Radboud University NijmegenKiyoyasu Kurahashi - Yokohama City Univ, Med Ctr, Dept Anesthesiol, Kanagawa, JapanJon Henrik Laake - Oslo University HospitalAnders Larsson - Uppsala UniversityDaniel F. McAuley - Queen's University BelfastLia McNamee - Queen's University BelfastNicolas Nin - Hospital Universitario de GetafeHaibo Qiu - Zhongda Hospital Southeast UniversityMarco Ranieri - Policlinico Umberto IGordon D. Rubenfeld - University of TorontoB. Taylor Thompson - Massachusetts General HospitalHermann Wrigge - Leipzig UniversityArthur S. Slutsky - University of TorontoAntonio Pesenti - Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoLUNG SAFE InvestigatorsESICM Trials Group
- Contributors
- Nicholas M Mohr (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine, Vol.42(12), pp.1865-1876
- DOI
- 10.1007/s00134-016-4571-5
- PMID
- 27757516
- NLM abbreviation
- Intensive Care Med
- ISSN
- 0342-4642
- eISSN
- 1432-1238
- Publisher
- Springer Nature
- Number of pages
- 12
- Grant note
- St Michael's Hospital, Toronto, Canada European Society of Intensive Care Medicine (ESICM), Brussels, Belgium University of Milan-Bicocca, Monza, Italy
- Language
- English
- Date published
- 12/01/2016
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984295927702771
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