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

Fabiana Madotto, Tai Pham, Giacomo Bellani, Lieuwe Bos, Fabienne Simonis, Eddy Fan, Antonio Artigas, Laurent Brochard, Marcus Schultz, John Laffey, Hektor Sula, Lordian Nunci, Alma Cani, Alan Zazu, Christian Dellera, Carolina Insaurralde, Risso Alejandro, Julio Daldin, Mauricio Vinzio, Ruben FernandezLuis 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

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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: NCT02010073.

Original languageEnglish
Pages (from-to)564-577
Number of pages14
JournalIntensive Care Medicine
Issue number5
Early online date2018
Publication statusPublished - 1 May 2018


  • ARDS reassessment
  • ARDS Survival
  • Berlin criteria ARDS
  • Persisting ARDS

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