Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study

LUNG SAFE Investigators and the ESICM Trials Group

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    28 Scopus citations

    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.

    Original languageEnglish
    Pages (from-to)564-577
    Number of pages14
    JournalIntensive Care Medicine
    Volume44
    Issue number5
    DOIs
    StatePublished - 1 May 2018

    Bibliographical note

    Funding Information:
    The detailed methods and protocol have been published elsewhere [1]. In brief, LUNG SAFE was an international, multicenter, prospective cohort study, with a 4-week enrollment window in the winter season [1]. The study, funded by the European Society of Intensive Care Medicine (ESICM), was endorsed by multiple national societies/networks (Online Appendix 1). All participating ICUs obtained ethics committee approval, and either patient consent or ethics committee waiver of consent, as appropriate. National coordinators (Online Appendix 1) and site investigators (Online Appendix 2) were responsible for obtaining ethics committee approval and for ensuring data integrity and validity.

    Publisher Copyright:
    © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.

    Keywords

    • ARDS Survival
    • ARDS reassessment
    • Berlin criteria ARDS
    • Persisting ARDS

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