Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

LUNG SAFE Investigators, the European Society of Intensive Care Medicine Trials Group, Tài Pham, Ary Serpa Neto, Paolo Pelosi, Candelaria De Haro, Jose Angel Lorente, Giacomo Bellani, Eddy Fan, Laurent Jean Brochard, Antonio Pesenti, Marcus Josephus Schultz, Antonio Artigas

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Editor's Perspective What We Already Know about This Topic Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected What This Article Tells Us That Is New Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses Background: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results: Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions: Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

Original languageEnglish
Pages (from-to)263-283
Number of pages21
JournalAnesthesiology
Volume130
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Adult Respiratory Distress Syndrome
Mortality
Hospital Mortality
Organ Dysfunction Scores
Oxygen
Population
Severe Acute Respiratory Syndrome
Partial Pressure

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

LUNG SAFE Investigators, the European Society of Intensive Care Medicine Trials Group, Pham, T., Serpa Neto, A., Pelosi, P., De Haro, C., ... Artigas, A. (2019). Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study. Anesthesiology, 130(2), 263-283. https://doi.org/10.1097/ALN.0000000000002508

Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome : Insights from the LUNG SAFE Study. / LUNG SAFE Investigators; the European Society of Intensive Care Medicine Trials Group; Pham, Tài; Serpa Neto, Ary; Pelosi, Paolo; De Haro, Candelaria; Lorente, Jose Angel; Bellani, Giacomo; Fan, Eddy; Brochard, Laurent Jean; Pesenti, Antonio; Schultz, Marcus Josephus; Artigas, Antonio.

In: Anesthesiology, Vol. 130, No. 2, 01.02.2019, p. 263-283.

Research output: Contribution to journalArticle

LUNG SAFE Investigators, the European Society of Intensive Care Medicine Trials Group, Pham, T, Serpa Neto, A, Pelosi, P, De Haro, C, Lorente, JA, Bellani, G, Fan, E, Brochard, LJ, Pesenti, A, Schultz, MJ & Artigas, A 2019, 'Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study', Anesthesiology, vol. 130, no. 2, pp. 263-283. https://doi.org/10.1097/ALN.0000000000002508
LUNG SAFE Investigators, the European Society of Intensive Care Medicine Trials Group, Pham T, Serpa Neto A, Pelosi P, De Haro C et al. Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study. Anesthesiology. 2019 Feb 1;130(2):263-283. https://doi.org/10.1097/ALN.0000000000002508
LUNG SAFE Investigators ; the European Society of Intensive Care Medicine Trials Group ; Pham, Tài ; Serpa Neto, Ary ; Pelosi, Paolo ; De Haro, Candelaria ; Lorente, Jose Angel ; Bellani, Giacomo ; Fan, Eddy ; Brochard, Laurent Jean ; Pesenti, Antonio ; Schultz, Marcus Josephus ; Artigas, Antonio. / Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome : Insights from the LUNG SAFE Study. In: Anesthesiology. 2019 ; Vol. 130, No. 2. pp. 263-283.
@article{9318100567bb41d099fa6ba803e58711,
title = "Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study",
abstract = "Editor's Perspective What We Already Know about This Topic Hospital mortality in acute respiratory distress syndrome is approximately 40{\%}, but mortality and trajectory in {"}mild{"} acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected What This Article Tells Us That Is New Approximately 80{\%} of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30{\%}) and is higher (37{\%}) in those in whom the acute respiratory distress syndrome progresses Background: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: {"}worsening{"} if moderate or severe acute respiratory distress syndrome criteria were met, {"}persisting{"} if mild acute respiratory distress syndrome criteria were the most severe category, and {"}improving{"} if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results: Among 580 patients with initial mild acute respiratory distress syndrome, 18{\%} (103 of 580) continuously improved, 36{\%} (210 of 580) had persisting mild acute respiratory distress syndrome, and 46{\%} (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30{\%} (172 of 576; specifically 10{\%} [10 of 101], 30{\%} [63 of 210], and 37{\%} [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions: Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.",
author = "{LUNG SAFE Investigators} and {the European Society of Intensive Care Medicine Trials Group} and T{\`a}i Pham and {Serpa Neto}, Ary and Paolo Pelosi and Laffey, {John Gerard} and {De Haro}, Candelaria and Lorente, {Jose Angel} and Giacomo Bellani and Eddy Fan and Brochard, {Laurent Jean} and Antonio Pesenti and Schultz, {Marcus Josephus} and Antonio Artigas and A. Esteban and L. Gattinoni and {van Haren}, F. and A. Larsson and McAuley, {D. F.} and M. Ranieri and G. Rubenfeld and Thompson, {B. T.} and H. Wrigge and Slutsky, {A. S.} and F. Rios and {Van Haren}, F. and T. Sottiaux and P. Depuydt and Lora, {F. S.} and Azevedo, {L. C.} and G. Bugedo and H. Qiu and M. Gonzalez and Pellegrini, {C. A.} and Loiacono, {F. A.} and A. Lombardo and A. Protti and A. Rossi and Antonelli, {M. M.} and Montini, {L. M.} and G. Panarello and G. Occhipinti and M. Pozzi and Poli, {M. M.} and G. Monti and R. Colombo and F. Mojoli and A. Braschi and Iotti, {G. A.} and A. Venti and Perez, {M. P.} and Vitale, {M. N.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1097/ALN.0000000000002508",
language = "English",
volume = "130",
pages = "263--283",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome

T2 - Insights from the LUNG SAFE Study

AU - LUNG SAFE Investigators

AU - the European Society of Intensive Care Medicine Trials Group

AU - Pham, Tài

AU - Serpa Neto, Ary

AU - Pelosi, Paolo

AU - Laffey, John Gerard

AU - De Haro, Candelaria

AU - Lorente, Jose Angel

AU - Bellani, Giacomo

AU - Fan, Eddy

AU - Brochard, Laurent Jean

AU - Pesenti, Antonio

AU - Schultz, Marcus Josephus

AU - Artigas, Antonio

AU - Esteban, A.

AU - Gattinoni, L.

AU - van Haren, F.

AU - Larsson, A.

AU - McAuley, D. F.

AU - Ranieri, M.

AU - Rubenfeld, G.

AU - Thompson, B. T.

AU - Wrigge, H.

AU - Slutsky, A. S.

AU - Rios, F.

AU - Van Haren, F.

AU - Sottiaux, T.

AU - Depuydt, P.

AU - Lora, F. S.

AU - Azevedo, L. C.

AU - Bugedo, G.

AU - Qiu, H.

AU - Gonzalez, M.

AU - Pellegrini, C. A.

AU - Loiacono, F. A.

AU - Lombardo, A.

AU - Protti, A.

AU - Rossi, A.

AU - Antonelli, M. M.

AU - Montini, L. M.

AU - Panarello, G.

AU - Occhipinti, G.

AU - Pozzi, M.

AU - Poli, M. M.

AU - Monti, G.

AU - Colombo, R.

AU - Mojoli, F.

AU - Braschi, A.

AU - Iotti, G. A.

AU - Venti, A.

AU - Perez, M. P.

AU - Vitale, M. N.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Editor's Perspective What We Already Know about This Topic Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected What This Article Tells Us That Is New Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses Background: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results: Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions: Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

AB - Editor's Perspective What We Already Know about This Topic Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected What This Article Tells Us That Is New Approximately 80% of cases of mild acute respiratory distress syndrome persist or worsen in the first week; in all cases, the mortality is substantial (30%) and is higher (37%) in those in whom the acute respiratory distress syndrome progresses Background: Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. Methods: This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. Results: Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. Conclusions: Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.

UR - http://www.scopus.com/inward/record.url?scp=85060572037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060572037&partnerID=8YFLogxK

U2 - 10.1097/ALN.0000000000002508

DO - 10.1097/ALN.0000000000002508

M3 - Article

C2 - 30499850

AN - SCOPUS:85060572037

VL - 130

SP - 263

EP - 283

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -