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Intensive Care Medicine
Published in: Intensive Care Medicine 5/2018

01-05-2018 | Original

Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study

Authors: Fabiana Madotto, Tài Pham, Giacomo Bellani, Lieuwe D. Bos, Fabienne D. Simonis, Eddy Fan, Antonio Artigas, Laurent Brochard, Marcus J. Schultz, John G. Laffey, LUNG SAFE Investigators and the ESICM Trials Group

Published in: Intensive Care Medicine | Issue 5/2018

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Abstract

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.
Appendix
Available only for authorised users
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Metadata
Title
Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study
Authors
Fabiana Madotto
Tài Pham
Giacomo Bellani
Lieuwe D. Bos
Fabienne D. Simonis
Eddy Fan
Antonio Artigas
Laurent Brochard
Marcus J. Schultz
John G. Laffey
LUNG SAFE Investigators and the ESICM Trials Group
Publication date
01-05-2018
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 5/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-018-5152-6

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