Journal article
Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study
Intensive care medicine, Vol.44(5), pp.564-577
04/09/2018
DOI: 10.1007/s00134-018-5152-6
PMID: 29632996
Abstract
Purpose
To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification.
Methods
Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24 h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification.
Results
Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01–1.13),
P
= 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both resolved and confirmed ARDS, age, non-respiratory SOFA score, lower PEEP and
P
/
F
ratio, higher peak pressure and respiratory rate were each associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal.
Conclusions
ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population.
Trial Registration
ClinicalTrials.gov NCT02010073.
Details
- Title: Subtitle
- Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study
- Creators
- Fabiana Madotto - University of Milano-BicoccaTài Pham - University of TorontoGiacomo Bellani - University of Milano-BicoccaLieuwe D. Bos - Amsterdam UMC Location University of AmsterdamFabienne D. Simonis - Amsterdam UMC Location University of AmsterdamEddy Fan - University of TorontoAntonio Artigas - Universitat Autònoma de BarcelonaLaurent Brochard - University of TorontoMarcus J. Schultz - Amsterdam UMC Location University of AmsterdamJohn G. Laffey - St. Michael's HospitalLUNG SAFE InvestigatorsEuropean Society of Intensive Care Medicine (ESICM) Trials Group
- Contributors
- Nicholas M Mohr (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Intensive care medicine, Vol.44(5), pp.564-577
- DOI
- 10.1007/s00134-018-5152-6
- PMID
- 29632996
- NLM abbreviation
- Intensive Care Med
- ISSN
- 0342-4642
- eISSN
- 1432-1238
- Publisher
- Springer Berlin Heidelberg
- Grant note
- European Society of Intensive Care Medicine University of Milan-Bicocca St Michael’s Hospital, Toronto, Canada
- Language
- English
- Date published
- 04/09/2018
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984296148602771
Metrics
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