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

Fabiana Madotto; Tài Pham; Giacomo Bellani; Lieuwe D. Bos; Fabienne D. Simonis; Eddy Fan; Antonio Artigas; Laurent Brochard; Marcus J. Schultz; John G. Laffey; Antonio Pesenti; Andres Esteban; Luciano Gattinoni; Frank van Haren; Anders Larsson; Daniel F. McAuley; Marco Ranieri; Gordon Rubenfeld; B. Taylor Thompson; Hermann Wrigge; Arthur S. Slutsky; Fernando Rios; Frank Van Haren; T. Sottiaux; P. Depuydt; Fredy S. Lora; Luciano Cesar Azevedo; Eddy Fan; Guillermo Bugedo; Haibo Qiu; Marcos Gonzalez; Juan Silesky; Vladimir Cerny; Jonas Nielsen; Manuel Jibaja; Hermann Wrigge; Dimitrios Matamis; Jorge Luis Ranero; Pravin Amin; S. M. Hashemian; Kevin Clarkson; Kiyoyasu Kurahashi; Asisclo Villagomez; Amine Ali Zeggwagh; Leo M. Heunks; Jon Henrik Laake; Jose Emmanuel Palo; Antero do Vale Fernandes; Dorel Sandesc; Yaasen Arabi; Vesna Bumbasierevic; Nicolas Nin; Jose A. Lorente; Anders Larsson; Lise Piquilloud; Fekri Abroug; Daniel F. McAuley; Lia McNamee; Javier Hurtado; Ed Bajwa; Gabriel Démpaire; Hektor Sula; Lordian Nunci; Alma Cani; Alan Zazu; Christian Dellera; Risso V. Alejandro; Julio Daldin; Mauricio Vinzio; Ruben O. Fernandez; Luis P. Cardonnet; Lisandro R. Bettini; Mariano Carboni Bisso; Emilio M. Osman; Mariano G. Setten; Pablo Lovazzano; Javier Alvarez; Veronica Villar; Norberto C. Pozo; Nicolas Grubissich; Gustavo A. Plotnikow; Daniela N. Vasquez; Santiago Ilutovich; Norberto Tiribelli; Ariel Chena; Carlos A. Pellegrini; María G. Saenz; Elisa Estenssoro; Matias Brizuela; Hernan Gianinetto; Pablo E. Gomez; Valeria I. Cerrato; Marco G. Bezzi; Silvina A. Borello; Flavia A. Loiacono; Adriana M. Fernandez; Serena Knowles; Claire Reynolds; Deborah M. Inskip; Jennene J. Miller

doi:10.1007/s00134-018-5152-6

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

Fabiana Madotto, Tài Pham, Giacomo Bellani, Lieuwe D. Bos, Fabienne D. Simonis, Eddy Fan, Antonio Artigas, Laurent Brochard, Marcus J. Schultz, John G. Laffey, Antonio Pesenti, Andres Esteban, Luciano Gattinoni, Frank van Haren, Anders Larsson, Daniel F. McAuley, Marco Ranieri, Gordon Rubenfeld, B. Taylor Thompson, Hermann WriggeArthur S. Slutsky, Fernando Rios, Frank Van Haren, T. Sottiaux, P. Depuydt, Fredy S. Lora, Luciano Cesar Azevedo, Eddy Fan, Guillermo Bugedo, Haibo Qiu, Marcos Gonzalez, Juan Silesky, Vladimir Cerny, Jonas Nielsen, Manuel Jibaja, Hermann Wrigge, Dimitrios Matamis, Jorge Luis Ranero, Pravin Amin, S. M. Hashemian, Kevin Clarkson, Kiyoyasu Kurahashi, Asisclo Villagomez, Amine Ali Zeggwagh, Leo M. Heunks, Jon Henrik Laake, Jose Emmanuel Palo, Antero do Vale Fernandes, Dorel Sandesc, Yaasen Arabi, Vesna Bumbasierevic, Nicolas Nin, Jose A. Lorente, Anders Larsson, Lise Piquilloud, Fekri Abroug, Daniel F. McAuley, Lia McNamee, Javier Hurtado, Ed Bajwa, Gabriel Démpaire, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Risso V. Alejandro, Julio Daldin, Mauricio Vinzio, Ruben O. Fernandez, Luis P. Cardonnet, Lisandro R. Bettini, Mariano Carboni Bisso, Emilio M. Osman, Mariano G. Setten, Pablo Lovazzano, Javier Alvarez, Veronica Villar, Norberto C. Pozo, Nicolas Grubissich, Gustavo A. Plotnikow, Daniela N. Vasquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos A. Pellegrini, María G. Saenz, Elisa Estenssoro, Matias Brizuela, Hernan Gianinetto, Pablo E. Gomez, Valeria I. Cerrato, Marco G. Bezzi, Silvina A. Borello, Flavia A. Loiacono, Adriana M. Fernandez, Serena Knowles, Claire Reynolds, Deborah M. Inskip, Jennene J. Miller

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

Idioma original	Anglès
Pàgines (de-a)	564-577
Revista	Intensive Care Medicine
Volum	44
Número	5
DOIs	https://doi.org/10.1007/s00134-018-5152-6
Estat de la publicació	Publicada - 1 de maig 2018

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10.1007/s00134-018-5152-6

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Madotto, F., Pham, T., Bellani, G., Bos, L. D., Simonis, F. D., Fan, E., Artigas, A., Brochard, L., Schultz, M. J., Laffey, J. G., Pesenti, A., Esteban, A., Gattinoni, L., van Haren, F., Larsson, A., McAuley, D. F., Ranieri, M., Rubenfeld, G., Thompson, B. T., ... Miller, J. J. (2018). Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study. Intensive Care Medicine, 44(5), 564-577. https://doi.org/10.1007/s00134-018-5152-6

@article{0c8e35c7e60f44d6ac1e0e038f787187,

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

abstract = "{\textcopyright} 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM. 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 = "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 Yaasen Arabi and Vesna Bumbasierevic and Nicolas Nin and Lorente, {Jose A.} and Anders Larsson and Lise Piquilloud and Fekri Abroug and McAuley, {Daniel F.} and Lia McNamee and Javier Hurtado and Ed Bajwa and Gabriel D{\'e}mpaire and Hektor Sula and Lordian Nunci and Alma Cani and Alan Zazu and Christian Dellera and Alejandro, {Risso V.} and Julio Daldin and Mauricio Vinzio and Fernandez, {Ruben O.} and Cardonnet, {Luis P.} and Bettini, {Lisandro R.} and Bisso, {Mariano Carboni} and Osman, {Emilio M.} and Setten, {Mariano G.} and Pablo Lovazzano and Javier Alvarez and Veronica Villar and Pozo, {Norberto C.} and Nicolas Grubissich and Plotnikow, {Gustavo A.} and Vasquez, {Daniela N.} and Santiago Ilutovich and Norberto Tiribelli and Ariel Chena and Pellegrini, {Carlos A.} and Saenz, {Mar{\'i}a G.} and Elisa Estenssoro and Matias Brizuela and Hernan Gianinetto and Gomez, {Pablo E.} and Cerrato, {Valeria I.} and Bezzi, {Marco G.} and Borello, {Silvina A.} and Loiacono, {Flavia A.} and Fernandez, {Adriana M.} and Serena Knowles and Claire Reynolds and Inskip, {Deborah M.} and Miller, {Jennene J.}",

year = "2018",

month = may,

day = "1",

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

language = "English",

volume = "44",

pages = "564--577",

journal = "Intensive Care Medicine",

issn = "0342-4642",

number = "5",

}

Madotto, F, Pham, T, Bellani, G, Bos, LD, Simonis, FD, Fan, E, Artigas, A, Brochard, L, Schultz, MJ, Laffey, JG, Pesenti, A, Esteban, A, Gattinoni, L, van Haren, F, Larsson, A, McAuley, DF, Ranieri, M, Rubenfeld, G, Thompson, BT, Wrigge, H, Slutsky, AS, Rios, F, Van Haren, F, Sottiaux, T, Depuydt, P, Lora, FS, Azevedo, LC, Fan, E, Bugedo, G, Qiu, H, Gonzalez, M, Silesky, J, Cerny, V, Nielsen, J, Jibaja, M, Wrigge, H, Matamis, D, Ranero, JL, Amin, P, Hashemian, SM, Clarkson, K, Kurahashi, K, Villagomez, A, Zeggwagh, AA, Heunks, LM, Laake, JH, Palo, JE, do Vale Fernandes, A, Sandesc, D, Arabi, Y, Bumbasierevic, V, Nin, N, Lorente, JA, Larsson, A, Piquilloud, L, Abroug, F, McAuley, DF, McNamee, L, Hurtado, J, Bajwa, E, Démpaire, G, Sula, H, Nunci, L, Cani, A, Zazu, A, Dellera, C, Alejandro, RV, Daldin, J, Vinzio, M, Fernandez, RO, Cardonnet, LP, Bettini, LR, Bisso, MC, Osman, EM, Setten, MG, Lovazzano, P, Alvarez, J, Villar, V, Pozo, NC, Grubissich, N, Plotnikow, GA, Vasquez, DN, Ilutovich, S, Tiribelli, N, Chena, A, Pellegrini, CA, Saenz, MG, Estenssoro, E, Brizuela, M, Gianinetto, H, Gomez, PE, Cerrato, VI, Bezzi, MG, Borello, SA, Loiacono, FA, Fernandez, AM, Knowles, S, Reynolds, C, Inskip, DM & Miller, JJ 2018, 'Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study', Intensive Care Medicine, vol. 44, núm. 5, pàg. 564-577. https://doi.org/10.1007/s00134-018-5152-6

TY - JOUR

T1 - Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study

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 - Arabi, Yaasen

AU - Bumbasierevic, Vesna

AU - Nin, Nicolas

AU - Lorente, Jose A.

AU - Larsson, Anders

AU - Piquilloud, Lise

AU - Abroug, Fekri

AU - McAuley, Daniel F.

AU - McNamee, Lia

AU - Hurtado, Javier

AU - Bajwa, Ed

AU - Démpaire, Gabriel

AU - Sula, Hektor

AU - Nunci, Lordian

AU - Cani, Alma

AU - Zazu, Alan

AU - Dellera, Christian

AU - Alejandro, Risso V.

AU - Daldin, Julio

AU - Vinzio, Mauricio

AU - Fernandez, Ruben O.

AU - Cardonnet, Luis P.

AU - Bettini, Lisandro R.

AU - Bisso, Mariano Carboni

AU - Osman, Emilio M.

AU - Setten, Mariano G.

AU - Lovazzano, Pablo

AU - Alvarez, Javier

AU - Villar, Veronica

AU - Pozo, Norberto C.

AU - Grubissich, Nicolas

AU - Plotnikow, Gustavo A.

AU - Vasquez, Daniela N.

AU - Ilutovich, Santiago

AU - Tiribelli, Norberto

AU - Chena, Ariel

AU - Pellegrini, Carlos A.

AU - Saenz, María G.

AU - Estenssoro, Elisa

AU - Brizuela, Matias

AU - Gianinetto, Hernan

AU - Gomez, Pablo E.

AU - Cerrato, Valeria I.

AU - Bezzi, Marco G.

AU - Borello, Silvina A.

AU - Loiacono, Flavia A.

AU - Fernandez, Adriana M.

AU - Knowles, Serena

AU - Reynolds, Claire

AU - Inskip, Deborah M.

AU - Miller, Jennene J.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM. 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 - © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM. 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

U2 - 10.1007/s00134-018-5152-6

DO - 10.1007/s00134-018-5152-6

M3 - Article

SN - 0342-4642

VL - 44

SP - 564

EP - 577

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 5

ER -

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

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