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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14 Citations (Scopus)

Abstract

© 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.
Original languageEnglish
Pages (from-to)564-577
JournalIntensive Care Medicine
Volume44
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Keywords

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

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