@article{d72ba27c4bf24de594f81c33410f2600,
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.",
keywords = "lung, respiratory distress syndrome, safe trial",
author = "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 {European Society of Intensive Care Medicine Trials Group} and {LUNG SAFE Investigators} and Andres Esteban and Luciano Gattinoni and {van Haren}, Frank and Anders Larsson and McAuley, {Daniel F.} and Marco Ranieri and Gordon Rubenfeld and Thompson, {B. Taylor} and Hermann Wrigge and Slutsky, {Arthur S.} and Fernando Rios and Thierry Sottiaux and Pieter Depuydt and Lora, {Fredy S.} and Azevedo, {Luciano Cesar} and Guillermo Bugedo and Haibo Qiu and Marcos Gonzales and Juan Silesky and Vladimir Cerny and Jonas Nielsen and Manuel Jibaja and Hermann Wrigge and Dimitrios Matamis and Ranero, {Jorge Luis} and Pravin Amin and Hashemian, {S. M.} and Kevin Clarkson and Kiyoyasu Kurahashi and Asisclo Villagomez and Zeggwagh, {Amine Ali} and Heunks, {Leo M.} and Laake, {Jon Henrik} and Palo, {Jose Emmanuel} and {do Vale Fernandes}, Antero and Dorel Sandesc and Yaasen Arabi and Vesna Bumbasierevic and Nicolas Nin and Lise Piquilloud and Fekri Abroug and Lia McNamee and Javier Hurtado and Ed Bajwa and Gabriel D{\'e}mpaire and Hektor Sula and Lordian Nunci and Alma Cani and Alan Zazu and Christian Dellera and Insaurralde, {Carolina S.} and Alejandro, {Risso V.} and Julio Daldin and Mauricio Vinzio and Fernandez, {Ruben O.} and Cardonnet, {Luis P.} and Bettini, {Lisandro R.} and Bisso, {Mariano Carboni} and Osman, {Emilio M.} and Setten, {Mariano G.} and Pablo Lovazzano and Javier Alvarez and Veronica Villar and Pozo, {Norberto C.} and Nicolas Grubissich and Plotnikow, {Gustavo A.} and Vasquez, {Daniela N.} and Santiago Ilutovich and Norberto Tiribelli and Ariel Chena and Pellegrini, {Carlos A.} and Saenz, {Maria G.} and Elisa Estenssoro and Matias Brizuela and Hernan Gianinetto and Gomez, {Pablo E.} and Cerrato, {Valeria I.} and Bezzi, {Marco G.} and Borello, {Silvina A.} and Loiacono, {Flavia A.} and Fernandez, {Adriana M.} and Serena Knowles and Claire Reynolds and Inskip, {Deborah M.} and Miller, {Jennene J.} and Jing Kong and Christina Whitehead and Shailesh Bihari and Aylin Seven and Amanda Krstevski and Rodgers, {Helen J.} and Millar, {Rebecca T.} and Mckenna, {Toni E.} and Bailey, {Irene M.} and Hanlon, {Gabrielle C.} and Anders Aneman and Lynch, {Joan M.} and Raman Azad and John Neal and Woods, {Paul W.} and Roberts, {Brigit L.} and Kol, {Mark R.} and Wong, {Helen S.} and Riss, {Katharina C.} and Thomas Staudinger and Xavier Wittebole and Caroline Berghe and Bulpa, {Pierre A.} and Dive, {Alain M.} and Rik Verstraete and Herve Lebbinck and Pieter Depuydt and Joris Vermassen and Philippe Meersseman and Helga Ceunen and Rosa, {Jonas I.} and Beraldo, {Daniel O.} and Claudio Piras and Rampinelli, {Adenilton M.} and Nassar, {Antonio P.} and Sergio Mataloun and Marcelo Moock and Thompson, {Marlus M.} and Gon{\c c}alves, {Claudio H.} and Ant{\^o}nio, {Ana Carolina P.} and Aline Ascoli and Biondi, {Rodrigo S.} and Fontenele, {Danielle C.} and Danielle Nobrega and Sales, {Vanessa M.} and {Bin HJ Abul Wahab}, {Ahmad Yazid} and Maizatul Ismail and Suresh Shindhe and Francois Beloncle and Davies, {Kyle G.} and Rob Cirone and Venika Manoharan and Mehvish Ismail and Goligher, {Ewan C.} and Mandeep Jassal and Erin Nishikawa and Areej Javeed and Gerard Curley and Nuttapol Rittayamai and Matteo Parotto and Ferguson, {Niall D.} and Sangeeta Mehta and Jenny Knoll and Antoine Pronovost and Sergio Canestrini and Bruhn, {Alejandro R.} and Garcia, {Patricio H.} and Aliaga, {Felipe A.} and Far{\'i}as, {Pamela A.} and Yumha, {Jacob S.} and Ortiz, {Claudia A.} and Salas, {Javier E.} and Saez, {Alejandro A.} and Vega, {Luis D.} and Labarca, {Eduardo F.} and Martinez, {Felipe T.} and Carre{\~n}o, {Nicolas G.} and Pilar Lora and Haitao Liu and Haibo Qiu and Ling Liu and Rui Tang and Xiaming Luo and Youzhong An and Huiying Zhao and Yan Gao and Zhe Zhai and Ye, {Zheng L.} and Wei Wang and Wenwen Li and Qingdong Li and Ruiqiang Zheng and Wenkui Yu and Juanhong Shen and Xinyu Li and Tao Yu and Weihua Lu and Wu, {Ya Q.} and Huang, {Xiao B.} and Zhenyang He and Yuanhua Lu and Hui Han and Fan Zhang and Renhua Sun and Wang, {Hua X.} and Qin, {Shu H.} and Zhu, {Bao H.} and Jun Zhao and Jian Liu and Bin Li and Liu, {Jing L.} and Zhou, {Fa C.} and Li, {Qiong J.} and Zhang, {Xing Y.} and Zhou Li-Xin and Qiang Xin-Hua and Liangyan Jiang and Gao, {Yuan N.} and Zhao, {Xian Y.} and Li, {Yuan Y.} and Li, {Xiao L.} and Chunting Wang and Qingchun Yao and Rongguo Yu and Kai Chen and Huanzhang Shao and Bingyu Qin and Huang, {Qing Q.} and Zhu, {Wei H.} and Hang, {Ai Y.} and Hua, {Ma X.} and Yimin Li and Yonghao Xu and Di, {Yu D.} and Ling, {Long L.} and Qin, {Tie H.} and Wang, {Shou H.} and Junping Qin and Yi Han and Suming Zhou and Vargas, {Monica P.} and {Silesky Jimenez}, {Juan I.} and {Gonz{\'a}lez Rojas}, {Manuel A.} and Solis-Quesada, {Jaime E.} and Ramirez-Alfaro, {Christian M.} and Jan M{\'a}ca and Peter Sklienka and Jakob Gjedsted and Aage Christiansen and Jonas Neilsen and Villamagua, {Boris G.} and Miguel Llano",
year = "2019",
month = feb,
doi = "10.1097/ALN.0000000000002508",
language = "English",
volume = "130",
pages = "263--283",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams & Wilkins",
number = "2",
}
