Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study
Open accessAbstract
Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse. Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful. Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy examines the current practice of NIV use in ARDS, the utility of the PaO2/FiO2 ratio in classifying patients receiving NIV, and the impact of NIV on outcome. Measurements and Main Results: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio was associated with an increase in intensity of ventilatory support, NIV failure, and intensive care unit (ICU) mortality. NIV failure occurred in 22.2% of mild, 42.3% of moderate, and 47.1% of patients with severe ARDS. Hospital mortality in patients with NIV success and failure was 16.1% and 45.4%, respectively. NIV use was independently associated with increased ICU (hazard ratio, 1.446 [95% confidence interval, 1.159–1.805]), but not hospital, mortality. In a propensity matched analysis, ICU mortality was higher in NIV than invasively ventilated patients with a PaO2/FiO2 lower than 150 mm Hg. Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).
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Evidence shows higher blood pressure at early and later time points, higher static filling pressures, and lower net fluid balance with albumin.
“The suggestion to consider albumin in patients who received large volumes of crystalloids is informed by evidence showing higher blood pressure at early and later time points (339), higher static filling pressures (340), and lower net fluid balance (339) with albumin.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [339]
Citation 340 is attached specifically to the claim of higher static filling pressures with albumin. The ORIGINAL ARTICLE tables (pp. 8 and 10) report respiratory and ventilation measures, not an albumin comparison or static filling pressures. Searches for those terms and for albumin, crystalloids, fluid balance, and blood pressure found no passage addressing that claim. (LLM, conf=0.77)
Experimental — accuracy not yet measuredAlbumin is theoretically more likely to maintain oncotic pressure than crystalloids, but it is more costly and there is no clear benefit with its routine use.
“Although albumin is theoretically more likely to maintain oncotic pressure than crystalloids (339), it is more costly and there is no clear benefit with its routine use.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [339]
The citation is attached to the claim that albumin is more likely than crystalloids to maintain oncotic pressure. Our copy discusses noninvasive ventilation in ARDS (What This Study Adds, p. 3; Discussion, p. 7), but the passages returned for searches on albumin, crystalloids, oncotic pressure, cost, and routine use do not address that comparison. (LLM, conf=0.77)
Experimental — accuracy not yet measuredThe ALBIOS trial comparing albumin plus crystalloids to crystalloids alone in 1,818 patients with sepsis or septic shock did not demonstrate a difference in 28-day (RR, 1.0; 95% CI, 0.87-1.14) or 90-day mortality (RR, 0.94; 95% CI, 0.85-1.05).
“The largest clinical trial in sepsis, the ALBIOS trial comparing a combination of albumin and crystalloids to crystalloids alone in 1,818 patients with sepsis or septic shock did not demonstrate a difference in 28-day (RR, 1.0; 95% CI, 0.87-1.14)or 90-day mortality (RR, 0.94; 95% CI, 0.85-1.05)(339).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [339]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe LUNG SAFE trial demonstrated that NIV was used in 15% of patients with ARDS with varying failure and mortality rates, depending on ARDS severity.
“For example, the LUNG SAFE trial demonstrated that NIV was used in 15% of patients with ARDS with varying failure and mortality rates, depending on ARDS severity [417].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [417]
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
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Self-citation
- Authors
- Bellani, G., Laffey, J. G., Pham, T., Madotto, F., Fan, E., Brochard, L., Esteban, A., Gattinoni, L., Bumbasirevic, V., Piquilloud, L., van Haren, F., Larsson, A., McAuley, D. F., Bauer, P. R., Arabi, Y. M., Ranieri, M., Antonelli, M., Rubenfeld, G. D., Thompson, B. T., Wrigge, H., Slutsky, A. S., & Pesenti, A.
- Affiliations
- Azienda Ospedaliera San Gerardo (IT)
- St. Michael's Hospital (CA)
- Inserm (FR)
- University of Milano-Bicocca (IT)
- Mount Sinai Hospital (CA)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES)
- Universitätsmedizin Göttingen (DE)
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Centre Hospitalier Universitaire Vaudois (CH)
- Intensive Care Unit, The Canberra Hospital, Canberra, Australia
- Uppsala University (SE)
- Queen's University Belfast (GB)
- Mayo Clinic (US)
- King Saud bin Abdulaziz University for Health Sciences (SA)
- Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Sapienza Università di Roma, Roma, Italy
- Università Cattolica del Sacro Cuore (IT)
- Sunnybrook Health Science Centre (CA)
- Harvard University (US)
- University Hospital Leipzig (DE)
- University of Milan (IT)
- Corresponding author
- Laffey, John G.
- ORCID
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-01-01
- Volume
- 195
- Issue
- 1
- Pages
- 67-77
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2536303762
- Cited by
- 667
- References
- 33
- Citations by year
- 2026: 47 · 2025: 37 · 2024: 54 · 2023: 75 · 2022: 105 · 2021: 129 · 2020: 97 · 2019: 43 · 2018: 44 · 2017: 33
- FWCI
- 35.75
- Type
- journal article
- Language
- en
- Open access
- green
- pure.qub.ac.uk
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (publishedVersion, other-oa)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- IRIS (submittedVersion)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Università degli Studi di Milano
- European Society of Intensive Care Medicine
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- non-invasive ventilation, acute respiratory distress syndrome, PaO2/FiO2 ratio, Berlin criteria, ARDS severity classification, NIV failure, ICU mortality, in-hospital mortality, invasive mechanical ventilation, acute respiratory failure
- MeSH terms
- Aged, Female, Humans, Intensive Care Units, Male, Middle Aged, Respiratory Distress Syndrome, Severity of Illness Index, Treatment Outcome, Hospital Mortality, Noninvasive Ventilation
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