Resolved versus confirmed ARDS after 24 h

insights from the LUNG SAFE study

LUNG SAFE Investigators and the ESICM Trials Group

    Research output: Contribution to journalArticle

    6 Citations (Scopus)

    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
    Publication statusPublished - 01-05-2018

    Fingerprint

    Mortality
    Tidal Volume
    Respiratory Rate
    Hospital Mortality
    Artificial Respiration
    Immunosuppression
    Pressure
    Population
    Neoplasms

    All Science Journal Classification (ASJC) codes

    • Critical Care and Intensive Care Medicine

    Cite this

    LUNG SAFE Investigators and the ESICM Trials Group. / Resolved versus confirmed ARDS after 24 h : insights from the LUNG SAFE study. In: Intensive Care Medicine. 2018 ; Vol. 44, No. 5. pp. 564-577.
    @article{1e248d0fb3a84ea0808979a4d6b078f6,
    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.",
    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 {Van Haren}, Frank 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, {S. M.} 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 Ramesh Unnikrishnan",
    year = "2018",
    month = "5",
    day = "1",
    doi = "10.1007/s00134-018-5152-6",
    language = "English",
    volume = "44",
    pages = "564--577",
    journal = "Intensive Care Medicine",
    issn = "0342-4642",
    publisher = "Springer Verlag",
    number = "5",

    }

    Resolved versus confirmed ARDS after 24 h : insights from the LUNG SAFE study. / LUNG SAFE Investigators and the ESICM Trials Group.

    In: Intensive Care Medicine, Vol. 44, No. 5, 01.05.2018, p. 564-577.

    Research output: Contribution to journalArticle

    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 - Van Haren, Frank

    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, S. M.

    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 - Unnikrishnan, Ramesh

    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.

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    U2 - 10.1007/s00134-018-5152-6

    DO - 10.1007/s00134-018-5152-6

    M3 - Article

    VL - 44

    SP - 564

    EP - 577

    JO - Intensive Care Medicine

    JF - Intensive Care Medicine

    SN - 0342-4642

    IS - 5

    ER -