Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

John G. Laffey, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, Ednan K. Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni, Frank van Haren, Leo M. Heunks, Kiyoyasu Kurahashi, Jon Henrik Laake, Anders Larsson, Daniel F. McAuley, Lia McNamee, Nicolas Nin, Haibo Qiu, Marco RanieriGordon D. Rubenfeld, B. Taylor Thompson, Hermann Wrigge, Arthur S. Slutsky, Antonio Maria Pesenti, LUNG SAFE Investigators The LUNG SAFE Investigators

Research output: Contribution to journalArticle

Abstract

Purpose: To improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality. Methods: The large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1–2 who received invasive mechanical ventilation. Results: 2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO2/FiO2 ratio, and higher non-pulmonary SOFA score were associated with poorer outcome. Of the 578 (24.3 %) patients with a limitation of life-sustaining therapies or measures decision, 498 (86.0 %) died in hospital. Factors associated with increased likelihood of limitation of life-sustaining therapies or measures decision included older age, immunosuppression, neoplasia, lower pH and increased non-pulmonary SOFA scores. Conclusions: Higher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS. Trial Registration: ClinicalTrials.gov NCT02010073.

Original languageEnglish
Pages (from-to)1865-1876
Number of pages12
JournalIntensive Care Medicine
Volume42
Issue number12
DOIs
Publication statusPublished - Dec 1 2016

Keywords

  • Acute respiratory distress syndrome
  • Driving pressure
  • Patient outcome
  • Peak inspiratory pressure
  • Positive end-expiratory pressure

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Laffey, J. G., Bellani, G., Pham, T., Fan, E., Madotto, F., Bajwa, E. K., Brochard, L., Clarkson, K., Esteban, A., Gattinoni, L., van Haren, F., Heunks, L. M., Kurahashi, K., Laake, J. H., Larsson, A., McAuley, D. F., McNamee, L., Nin, N., Qiu, H., ... The LUNG SAFE Investigators, LUNG. SAFE. I. (2016). Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Medicine, 42(12), 1865-1876. https://doi.org/10.1007/s00134-016-4571-5