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Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: The LUNG SAFE study.
Open accessAbstract
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 PaO 2/FiO 2 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.
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“LUNGSAFE, a large international observational study, which reported that plateau pressure correlated with mortality; however, the relationship between the two was not evident when plateau pressure was below 20 cm H2O [435].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [435]
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Self-citationNeuromuscular Blockers in Early Acute Respiratory Distress Syndrome
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Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935
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Formal guidelines: Management of acute respiratory distress syndrome.
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Self-citationMechanical Ventilation: State of the Art
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Metadata
- Authors
- Laffey, J. G., Bellani, G., Pham, T., Fan, E., Madotto, F., Bajwa, E. K., Brochard, L., Clarkson, K., Esteban, A., Gattinoni, L., van Haren, F., Heunks, L. M., Kurahashi, K., Laake, J. H., Larsson, A., McAuley, D. F., McNamee, L., Nin, N., Qiu, H., Ranieri, M., Rubenfeld, G. D., Thompson, B. T., Wrigge, H., Slutsky, A. S., Pesenti, A., & The LUNG SAFE Investigators and the ESICM Trials Group
- Affiliations
- St. Michael's Hospital (CA)
- Azienda Ospedaliera San Gerardo (IT)
- Inserm (FR)
- Mount Sinai Hospital (CA)
- University of Milano-Bicocca (IT)
- Harvard University (US)
- Ollscoil na Gaillimhe – University of Galway (IE)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
- Universitätsmedizin Göttingen (DE)
- Radboud University Medical Center (NL)
- Yokohama City University Medical Center (JP)
- Oslo University Hospital (NO)
- Uppsala University (SE)
- Queen's University Belfast (GB)
- Zhongda Hospital Southeast University (CN)
- Sunnybrook Health Science Centre (CA)
- Leipzig University (DE)
- University of Milan (IT)
- Corresponding author
- Laffey, John G.
- ORCID
- Venue
- Intensive Care Medicine
- Published
- 2016-10-18
- Volume
- 42
- Issue
- 12
- Pages
- 1865-1876
- ISSN
- 0342-4642 (ISSN-L)
- 1432-1238
- OpenAlex
- W2536799499
- Cited by
- 378
- References
- 31
- Citations by year
- 2026: 18 · 2025: 36 · 2024: 40 · 2023: 30 · 2022: 69 · 2021: 41 · 2020: 38 · 2019: 33 · 2018: 38 · 2017: 34 · 2016: 1
- FWCI
- 31.58
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-11-14)
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- Locations
- Intensive Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Digital Access to Libraries (Université catholique de Louvain (UCL), l'Université de Namur (UNamur) and the Université Saint-Louis (USL-B)) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- GRO (submittedVersion, cc-by)
- Research Portal (Queen's University Belfast) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- European Society of Intensive Care Medicine
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Keywords
- acute respiratory distress syndrome, ARDS mortality, modifiable risk factors, positive end-expiratory pressure, respiratory rate, tidal volume, ICU bed availability, PaO2/FiO2 ratio, immunosuppression, cancer, chronic liver failure
- MeSH terms
- Adult, Aged, Female, Humans, Intensive Care Units, Male, Middle Aged, Prospective Studies, Respiration, Artificial, Respiratory Distress Syndrome, Risk Factors, Severity of Illness Index, Tidal Volume, Comorbidity, Treatment Outcome, Hospital Mortality
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