Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study
Top Cited Papers
- 18 October 2016
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 42 (12), 1865-1876
- https://doi.org/10.1007/s00134-016-4571-5
Abstract
To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. 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. 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/FiO2 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. Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS. ClinicalTrials.gov NCT02010073.Keywords
Funding Information
- European Society of Intensive Care Medicine
This publication has 28 references indexed in Scilit:
- Neuromuscular Blockers in Early Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2010
- Effects of respiratory rate on ventilator-induced lung injury at a constant Paco2 in a mouse model of normal lungCritical Care Medicine, 2008
- Epidemiology and Outcomes of Acute Lung InjurySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2007
- Hypercapnic acidosis and mortality in acute lung injury*Critical Care Medicine, 2006
- Tidal Volume Reduction in Patients with Acute Lung Injury When Plateau Pressures Are Not HighAmerican Journal of Respiratory and Critical Care Medicine, 2005
- Incidence and Outcomes of Acute Lung InjuryThe New England Journal of Medicine, 2005
- Epidemiology and outcome of acute lung injury in European intensive care unitsIntensive Care Medicine, 2004
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2000
- Effect of a Protective-Ventilation Strategy on Mortality in the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 1998
- Why do patients die on general wards after discharge from intensive care units?Anaesthesia, 1997