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

John Laffey; Giacomo Bellani; Tai Pham; Eddy Fan; Fabiana Madotto; Ednan Bajwa; Laurent Brochard; Kevin Clarkson; Andres Esteban; Luciano Gattinoni; Frank van Haren; Leo Heunks; Kiyoyasu Kurahashi; Jon Laake; Anders Larsson; Daniel McAuley; Lia McNamee; Nicolas Nin; Haibo Qiu; Marco Ranieri; Gordon Rubenfeld; B Taylor Thompson; Hermann Wrigge; Arthur Slutsky; Guy Francois; Francesca Rabboni; Sara Conti; Hektor Sula; Lordian Nunci; Alan Zazu; Christian Dellera; Carolina Insaurralde; Sanatorio Las Lomas; Risso Alejandro; Julio Daldin; Mauricio Vinzio; Ruben Fernandez; Luis Cardonnet; Lisandro Bettini; Mariano Bisso; Emilio Osman; Mariano Setten; Pablo Lovazzano; Javier Alvarez; Veronica Villar; Cesar Milstein; Norberto Pozo; Nicolas Grubissich; Gustavo Plotnikow; Daniela Vasquez; Santiago Ilutovich; Norberto Tiribelli; Ariel Chena; Carlos Pellegrini; Maria Saenz; Elisa Estenssoro; Matias Brizuela; Hernan Gianinetto; Pablo Gomez; Valeria Cerrato; Marco Bezzi; Silvina Borello; Flavia Loiacono; Adriana Fernandez; Serena Knowles; Claire Reynolds; Deborah Inskip; Jennene Miller; Jing Kong; Christina Whitehead; Shailesh Bihari

doi:10.1007/s00134-016-4571-5

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

John Laffey, Giacomo Bellani, Tai Pham, Eddy Fan, Fabiana Madotto, Ednan Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni, Frank van Haren, Leo Heunks, Kiyoyasu Kurahashi, Jon Laake, Anders Larsson, Daniel McAuley, Lia McNamee, Nicolas Nin, Haibo Qiu, Marco RanieriGordon Rubenfeld, B Taylor Thompson, Hermann Wrigge, Arthur Slutsky, Guy Francois, Francesca Rabboni, Sara Conti, Hektor Sula, Lordian Nunci, Alan Zazu, Christian Dellera, Carolina Insaurralde, Sanatorio Las Lomas, Risso Alejandro, Julio Daldin, Mauricio Vinzio, Ruben Fernandez, Luis Cardonnet, Lisandro Bettini, Mariano Bisso, Emilio Osman, Mariano Setten, Pablo Lovazzano, Javier Alvarez, Veronica Villar, Cesar Milstein, Norberto Pozo, Nicolas Grubissich, Gustavo Plotnikow, Daniela Vasquez, Santiago Ilutovich, Norberto Tiribelli, Ariel Chena, Carlos Pellegrini, Maria Saenz, Elisa Estenssoro, Matias Brizuela, Hernan Gianinetto, Pablo Gomez, Valeria Cerrato, Marco Bezzi, Silvina Borello, Flavia Loiacono, Adriana Fernandez, Serena Knowles, Claire Reynolds, Deborah Inskip, Jennene Miller, Jing Kong, Christina Whitehead, Shailesh Bihari

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

196 Citations (Scopus)

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 language	English
Pages (from-to)	1865-1876
Number of pages	12
Journal	Intensive Care Medicine
Volume	42
Issue number	12
DOIs	https://doi.org/10.1007/s00134-016-4571-5
Publication status	Published - 1 Dec 2016

Keywords

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

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10.1007/s00134-016-4571-5

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Laffey, J., Bellani, G., Pham, T., Fan, E., Madotto, F., Bajwa, E., Brochard, L., Clarkson, K., Esteban, A., Gattinoni, L., van Haren, F., Heunks, L., Kurahashi, K., Laake, J., Larsson, A., McAuley, D., McNamee, L., Nin, N., Qiu, H., ... Bihari, S. (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

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

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.",

keywords = "Acute respiratory distress syndrome, Driving pressure, Patient outcome, Peak inspiratory pressure, Positive end-expiratory pressure",

author = "John Laffey and Giacomo Bellani and Tai Pham and Eddy Fan and Fabiana Madotto and Ednan Bajwa and Laurent Brochard and Kevin Clarkson and Andres Esteban and Luciano Gattinoni and {van Haren}, Frank and Leo Heunks and Kiyoyasu Kurahashi and Jon Laake and Anders Larsson and Daniel McAuley and Lia McNamee and Nicolas Nin and Haibo Qiu and Marco Ranieri and Gordon Rubenfeld and Thompson, {B Taylor} and Hermann Wrigge and Arthur Slutsky and Guy Francois and Francesca Rabboni and Sara Conti and Hektor Sula and Lordian Nunci and Alan Zazu and Christian Dellera and Carolina Insaurralde and {Las Lomas}, Sanatorio and Risso Alejandro and Julio Daldin and Mauricio Vinzio and Ruben Fernandez and Luis Cardonnet and Lisandro Bettini and Mariano Bisso and Emilio Osman and Mariano Setten and Pablo Lovazzano and Javier Alvarez and Veronica Villar and Cesar Milstein and Norberto Pozo and Nicolas Grubissich and Gustavo Plotnikow and Daniela Vasquez and Santiago Ilutovich and Norberto Tiribelli and Ariel Chena and Carlos Pellegrini and Maria Saenz and Elisa Estenssoro and Matias Brizuela and Hernan Gianinetto and Pablo Gomez and Valeria Cerrato and Marco Bezzi and Silvina Borello and Flavia Loiacono and Adriana Fernandez and Serena Knowles and Claire Reynolds and Deborah Inskip and Jennene Miller and Jing Kong and Christina Whitehead and Shailesh Bihari",

year = "2016",

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doi = "10.1007/s00134-016-4571-5",

language = "English",

volume = "42",

pages = "1865--1876",

journal = "Intensive Care Medicine",

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Laffey, J, Bellani, G, Pham, T, Fan, E, Madotto, F, Bajwa, E, Brochard, L, Clarkson, K, Esteban, A, Gattinoni, L, van Haren, F, Heunks, L, Kurahashi, K, Laake, J, Larsson, A, McAuley, D, McNamee, L, Nin, N, Qiu, H, Ranieri, M, Rubenfeld, G, Thompson, BT, Wrigge, H, Slutsky, A, Francois, G, Rabboni, F, Conti, S, Sula, H, Nunci, L, Zazu, A, Dellera, C, Insaurralde, C, Las Lomas, S, Alejandro, R, Daldin, J, Vinzio, M, Fernandez, R, Cardonnet, L, Bettini, L, Bisso, M, Osman, E, Setten, M, Lovazzano, P, Alvarez, J, Villar, V, Milstein, C, Pozo, N, Grubissich, N, Plotnikow, G, Vasquez, D, Ilutovich, S, Tiribelli, N, Chena, A, Pellegrini, C, Saenz, M, Estenssoro, E, Brizuela, M, Gianinetto, H, Gomez, P, Cerrato, V, Bezzi, M, Borello, S, Loiacono, F, Fernandez, A, Knowles, S, Reynolds, C, Inskip, D, Miller, J, Kong, J, Whitehead, C & Bihari, S 2016, 'Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study', Intensive Care Medicine, vol. 42, no. 12, pp. 1865-1876. https://doi.org/10.1007/s00134-016-4571-5

TY - JOUR

T1 - Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

AU - Laffey, John

AU - Bellani, Giacomo

AU - Pham, Tai

AU - Fan, Eddy

AU - Madotto, Fabiana

AU - Bajwa, Ednan

AU - Brochard, Laurent

AU - Clarkson, Kevin

AU - Esteban, Andres

AU - Gattinoni, Luciano

AU - van Haren, Frank

AU - Heunks, Leo

AU - Kurahashi, Kiyoyasu

AU - Laake, Jon

AU - Larsson, Anders

AU - McAuley, Daniel

AU - McNamee, Lia

AU - Nin, Nicolas

AU - Qiu, Haibo

AU - Ranieri, Marco

AU - Rubenfeld, Gordon

AU - Thompson, B Taylor

AU - Wrigge, Hermann

AU - Slutsky, Arthur

AU - Francois, Guy

AU - Rabboni, Francesca

AU - Conti, Sara

AU - Sula, Hektor

AU - Nunci, Lordian

AU - Zazu, Alan

AU - Dellera, Christian

AU - Insaurralde, Carolina

AU - Las Lomas, Sanatorio

AU - Alejandro, Risso

AU - Daldin, Julio

AU - Vinzio, Mauricio

AU - Fernandez, Ruben

AU - Cardonnet, Luis

AU - Bettini, Lisandro

AU - Bisso, Mariano

AU - Osman, Emilio

AU - Setten, Mariano

AU - Lovazzano, Pablo

AU - Alvarez, Javier

AU - Villar, Veronica

AU - Milstein, Cesar

AU - Pozo, Norberto

AU - Grubissich, Nicolas

AU - Plotnikow, Gustavo

AU - Vasquez, Daniela

AU - Ilutovich, Santiago

AU - Tiribelli, Norberto

AU - Chena, Ariel

AU - Pellegrini, Carlos

AU - Saenz, Maria

AU - Estenssoro, Elisa

AU - Brizuela, Matias

AU - Gianinetto, Hernan

AU - Gomez, Pablo

AU - Cerrato, Valeria

AU - Bezzi, Marco

AU - Borello, Silvina

AU - Loiacono, Flavia

AU - Fernandez, Adriana

AU - Knowles, Serena

AU - Reynolds, Claire

AU - Inskip, Deborah

AU - Miller, Jennene

AU - Kong, Jing

AU - Whitehead, Christina

AU - Bihari, Shailesh

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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.

AB - 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.

KW - Acute respiratory distress syndrome

KW - Driving pressure

KW - Patient outcome

KW - Peak inspiratory pressure

KW - Positive end-expiratory pressure

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U2 - 10.1007/s00134-016-4571-5

DO - 10.1007/s00134-016-4571-5

M3 - Article

SN - 0342-4642

VL - 42

SP - 1865

EP - 1876

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 12

ER -

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

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Keywords

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