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 - Uppalapati, Aditya
N1 - Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM.
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 - Article
C2 - 29632996
AN - SCOPUS:85045095335
SN - 0342-4642
VL - 44
SP - 564
EP - 577
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 5
ER -