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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2016

01-12-2016 | Seven-Day Profile Publication

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

Authors: 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 Ranieri, Gordon D. Rubenfeld, B. Taylor Thompson, Hermann Wrigge, Arthur S. Slutsky, Antonio Pesenti, The LUNG SAFE Investigators and the ESICM Trials Group

Published in: Intensive Care Medicine | Issue 12/2016

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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.
Appendix
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Metadata
Title
Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study
Authors
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 Ranieri
Gordon D. Rubenfeld
B. Taylor Thompson
Hermann Wrigge
Arthur S. Slutsky
Antonio Pesenti
The LUNG SAFE Investigators and the ESICM Trials Group
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 12/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4571-5

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