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

LUNG SAFE Investigators and the ESICM Trials Group

doi:10.1007/s00134-018-5152-6

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 language	English
Pages (from-to)	564-577
Number of pages	14
Journal	Intensive Care Medicine
Volume	44
Issue number	5
DOIs	https://doi.org/10.1007/s00134-018-5152-6
State	Published - 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

Access to Document

10.1007/s00134-018-5152-6

Cite this

@article{a4a54363dbfa4ae9adef4747e1f17239,

title = "Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study",

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.",

keywords = "ARDS Survival, ARDS reassessment, Berlin criteria ARDS, Persisting ARDS",

author = "{LUNG SAFE Investigators and the ESICM Trials Group} and Fabiana Madotto and T{\`a}i Pham and Giacomo Bellani and Bos, {Lieuwe D.} and Simonis, {Fabienne D.} and Eddy Fan and Antonio Artigas and Laurent Brochard and Schultz, {Marcus J.} and Laffey, {John G.} and Antonio Pesenti and Andres Esteban and Luciano Gattinoni and {van Haren}, Frank and Anders Larsson and McAuley, {Daniel F.} and Marco Ranieri and Gordon Rubenfeld and Thompson, {B. Taylor} and Hermann Wrigge and Slutsky, {Arthur S.} and Fernando Rios and T. Sottiaux and P. Depuydt and Lora, {Fredy S.} and Azevedo, {Luciano Cesar} and Eddy Fan and Guillermo Bugedo and Haibo Qiu and Marcos Gonzalez and Juan Silesky and Vladimir Cerny and Jonas Nielsen and Manuel Jibaja and Hermann Wrigge and Dimitrios Matamis and Ranero, {Jorge Luis} and Pravin Amin and Hashemian, {Seyed Mohammad Reza} and Kevin Clarkson and Kiyoyasu Kurahashi and Asisclo Villagomez and Zeggwagh, {Amine Ali} and Heunks, {Leo M.} and Laake, {Jon Henrik} and Palo, {Jose Emmanuel} and {do Vale Fernandes}, Antero and Dorel Sandesc and Yaasen Arabi and Vesna Bumbasierevic",

note = "Publisher Copyright: {\textcopyright} 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.",

year = "2018",

month = may,

day = "1",

doi = "10.1007/s00134-018-5152-6",

language = "Ingl{\'e}s",

volume = "44",

pages = "564--577",

journal = "Intensive Care Medicine",

issn = "0342-4642",

number = "5",

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TY - JOUR

T1 - Resolved versus confirmed ARDS after 24 h

T2 - insights from the LUNG SAFE study

AU - LUNG SAFE Investigators and the ESICM Trials Group

AU - Madotto, Fabiana

AU - Pham, Tài

AU - Bellani, Giacomo

AU - Bos, Lieuwe D.

AU - Simonis, Fabienne D.

AU - Fan, Eddy

AU - Artigas, Antonio

AU - Brochard, Laurent

AU - Schultz, Marcus J.

AU - Laffey, John G.

AU - Pesenti, Antonio

AU - Esteban, Andres

AU - Gattinoni, Luciano

AU - van Haren, Frank

AU - Larsson, Anders

AU - McAuley, Daniel F.

AU - Ranieri, Marco

AU - Rubenfeld, Gordon

AU - Thompson, B. Taylor

AU - Wrigge, Hermann

AU - Slutsky, Arthur S.

AU - Rios, Fernando

AU - Sottiaux, T.

AU - Depuydt, P.

AU - Lora, Fredy S.

AU - Azevedo, Luciano Cesar

AU - Fan, Eddy

AU - Bugedo, Guillermo

AU - Qiu, Haibo

AU - Gonzalez, Marcos

AU - Silesky, Juan

AU - Cerny, Vladimir

AU - Nielsen, Jonas

AU - Jibaja, Manuel

AU - Wrigge, Hermann

AU - Matamis, Dimitrios

AU - Ranero, Jorge Luis

AU - Amin, Pravin

AU - Hashemian, Seyed Mohammad Reza

AU - Clarkson, Kevin

AU - Kurahashi, Kiyoyasu

AU - Villagomez, Asisclo

AU - Zeggwagh, Amine Ali

AU - Heunks, Leo M.

AU - Laake, Jon Henrik

AU - Palo, Jose Emmanuel

AU - do Vale Fernandes, Antero

AU - Sandesc, Dorel

AU - Arabi, Yaasen

AU - Bumbasierevic, Vesna

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

KW - ARDS Survival

KW - ARDS reassessment

KW - Berlin criteria ARDS

KW - Persisting ARDS

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U2 - 10.1007/s00134-018-5152-6

DO - 10.1007/s00134-018-5152-6

M3 - Artículo

C2 - 29632996

AN - SCOPUS:85045095335

VL - 44

SP - 564

EP - 577

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 5