Resolved versus confirmed ARDS after 24 h : insights from the LUNG SAFE study
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: ClinicalTrials.gov NCT02010073.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:44 |
|---|---|
| Enthalten in: |
Intensive care medicine - 44(2018), 5 vom: 09. Mai, Seite 564-577 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Madotto, Fabiana [VerfasserIn] |
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| Links: |
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| Themen: |
ARDS Survival |
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| Anmerkungen: |
Date Completed 11.12.2018 Date Revised 09.12.2020 published: Print-Electronic ClinicalTrials.gov: NCT02010073 Citation Status MEDLINE |
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| doi: |
10.1007/s00134-018-5152-6 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM282818715 |
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| 041 | |a eng | ||
| 100 | 1 | |a Madotto, Fabiana |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Resolved versus confirmed ARDS after 24 h |b insights from the LUNG SAFE study |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 11.12.2018 | ||
| 500 | |a Date Revised 09.12.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02010073 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a TRIAL REGISTRATION: ClinicalTrials.gov NCT02010073 | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ARDS Survival | |
| 650 | 4 | |a ARDS reassessment | |
| 650 | 4 | |a Berlin criteria ARDS | |
| 650 | 4 | |a Persisting ARDS | |
| 700 | 1 | |a Pham, Tài |e verfasserin |4 aut | |
| 700 | 1 | |a Bellani, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Bos, Lieuwe D |e verfasserin |4 aut | |
| 700 | 1 | |a Simonis, Fabienne D |e verfasserin |4 aut | |
| 700 | 1 | |a Fan, Eddy |e verfasserin |4 aut | |
| 700 | 1 | |a Artigas, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Brochard, Laurent |e verfasserin |4 aut | |
| 700 | 1 | |a Schultz, Marcus J |e verfasserin |4 aut | |
| 700 | 1 | |a Laffey, John G |e verfasserin |4 aut | |
| 700 | 0 | |a LUNG SAFE Investigators and the ESICM Trials Group |e verfasserin |4 aut | |
| 700 | 1 | |a Pesenti, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Esteban, Andres |e investigator |4 oth | |
| 700 | 1 | |a Gattinoni, Luciano |e investigator |4 oth | |
| 700 | 1 | |a van Haren, Frank |e investigator |4 oth | |
| 700 | 1 | |a Larsson, Anders |e investigator |4 oth | |
| 700 | 1 | |a McAuley, Daniel F |e investigator |4 oth | |
| 700 | 1 | |a Ranieri, Marco |e investigator |4 oth | |
| 700 | 1 | |a Rubenfeld, Gordon |e investigator |4 oth | |
| 700 | 1 | |a Thompson, B Taylor |e investigator |4 oth | |
| 700 | 1 | |a Wrigge, Hermann |e investigator |4 oth | |
| 700 | 1 | |a Slutsky, Arthur S |e investigator |4 oth | |
| 700 | 1 | |a Rios, Fernando |e investigator |4 oth | |
| 700 | 1 | |a Van Haren, Frank |e investigator |4 oth | |
| 700 | 1 | |a Sottiaux, T |e investigator |4 oth | |
| 700 | 1 | |a Depuydt, P |e investigator |4 oth | |
| 700 | 1 | |a Lora, Fredy S |e investigator |4 oth | |
| 700 | 1 | |a Azevedo, Luciano Cesar |e investigator |4 oth | |
| 700 | 1 | |a Fan, Eddy |e investigator |4 oth | |
| 700 | 1 | |a Bugedo, Guillermo |e investigator |4 oth | |
| 700 | 1 | |a Qiu, Haibo |e investigator |4 oth | |
| 700 | 1 | |a Gonzalez, Marcos |e investigator |4 oth | |
| 700 | 1 | |a Silesky, Juan |e investigator |4 oth | |
| 700 | 1 | |a Cerny, Vladimir |e investigator |4 oth | |
| 700 | 1 | |a Nielsen, Jonas |e investigator |4 oth | |
| 700 | 1 | |a Jibaja, Manuel |e investigator |4 oth | |
| 700 | 1 | |a Wrigge, Hermann |e investigator |4 oth | |
| 700 | 1 | |a Matamis, Dimitrios |e investigator |4 oth | |
| 700 | 1 | |a Ranero, Jorge Luis |e investigator |4 oth | |
| 700 | 1 | |a Amin, Pravin |e investigator |4 oth | |
| 700 | 1 | |a Hashemian, S M |e investigator |4 oth | |
| 700 | 1 | |a Clarkson, Kevin |e investigator |4 oth | |
| 700 | 1 | |a Kurahashi, Kiyoyasu |e investigator |4 oth | |
| 700 | 1 | |a Villagomez, Asisclo |e investigator |4 oth | |
| 700 | 1 | |a Zeggwagh, Amine Ali |e investigator |4 oth | |
| 700 | 1 | |a Heunks, Leo M |e investigator |4 oth | |
| 700 | 1 | |a Laake, Jon Henrik |e investigator |4 oth | |
| 700 | 1 | |a Palo, Jose Emmanuel |e investigator |4 oth | |
| 700 | 1 | |a do Vale Fernandes, Antero |e investigator |4 oth | |
| 700 | 1 | |a Sandesc, Dorel |e investigator |4 oth | |
| 700 | 1 | |a Arabi, Yaasen |e investigator |4 oth | |
| 700 | 1 | |a Bumbasierevic, Vesna |e investigator |4 oth | |
| 700 | 1 | |a Nin, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Lorente, Jose A |e investigator |4 oth | |
| 700 | 1 | |a Larsson, Anders |e investigator |4 oth | |
| 700 | 1 | |a Piquilloud, Lise |e investigator |4 oth | |
| 700 | 1 | |a Abroug, Fekri |e investigator |4 oth | |
| 700 | 1 | |a McAuley, Daniel F |e investigator |4 oth | |
| 700 | 1 | |a McNamee, Lia |e investigator |4 oth | |
| 700 | 1 | |a Hurtado, Javier |e investigator |4 oth | |
| 700 | 1 | |a Bajwa, Ed |e investigator |4 oth | |
| 700 | 1 | |a Démpaire, Gabriel |e investigator |4 oth | |
| 700 | 1 | |a Sula, Hektor |e investigator |4 oth | |
| 700 | 1 | |a Nunci, Lordian |e investigator |4 oth | |
| 700 | 1 | |a Cani, Alma |e investigator |4 oth | |
| 700 | 1 | |a Zazu, Alan |e investigator |4 oth | |
| 700 | 1 | |a Dellera, Christian |e investigator |4 oth | |
| 700 | 1 | |a Alejandro, Risso V |e investigator |4 oth | |
| 700 | 1 | |a Daldin, Julio |e investigator |4 oth | |
| 700 | 1 | |a Vinzio, Mauricio |e investigator |4 oth | |
| 700 | 1 | |a Fernandez, Ruben O |e investigator |4 oth | |
| 700 | 1 | |a Cardonnet, Luis P |e investigator |4 oth | |
| 700 | 1 | |a Bettini, Lisandro R |e investigator |4 oth | |
| 700 | 1 | |a Bisso, Mariano Carboni |e investigator |4 oth | |
| 700 | 1 | |a Osman, Emilio M |e investigator |4 oth | |
| 700 | 1 | |a Setten, Mariano G |e investigator |4 oth | |
| 700 | 1 | |a Lovazzano, Pablo |e investigator |4 oth | |
| 700 | 1 | |a Alvarez, Javier |e investigator |4 oth | |
| 700 | 1 | |a Villar, Veronica |e investigator |4 oth | |
| 700 | 1 | |a Pozo, Norberto C |e investigator |4 oth | |
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| 700 | 1 | |a Plotnikow, Gustavo A |e investigator |4 oth | |
| 700 | 1 | |a Vasquez, Daniela N |e investigator |4 oth | |
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| 700 | 1 | |a Tiribelli, Norberto |e investigator |4 oth | |
| 700 | 1 | |a Chena, Ariel |e investigator |4 oth | |
| 700 | 1 | |a Pellegrini, Carlos A |e investigator |4 oth | |
| 700 | 1 | |a Saenz, María G |e investigator |4 oth | |
| 700 | 1 | |a Estenssoro, Elisa |e investigator |4 oth | |
| 700 | 1 | |a Brizuela, Matias |e investigator |4 oth | |
| 700 | 1 | |a Gianinetto, Hernan |e investigator |4 oth | |
| 700 | 1 | |a Gomez, Pablo E |e investigator |4 oth | |
| 700 | 1 | |a Cerrato, Valeria I |e investigator |4 oth | |
| 700 | 1 | |a Bezzi, Marco G |e investigator |4 oth | |
| 700 | 1 | |a Borello, Silvina A |e investigator |4 oth | |
| 700 | 1 | |a Loiacono, Flavia A |e investigator |4 oth | |
| 700 | 1 | |a Fernandez, Adriana M |e investigator |4 oth | |
| 700 | 1 | |a Knowles, Serena |e investigator |4 oth | |
| 700 | 1 | |a Reynolds, Claire |e investigator |4 oth | |
| 700 | 1 | |a Inskip, Deborah M |e investigator |4 oth | |
| 700 | 1 | |a Miller, Jennene J |e investigator |4 oth | |
| 700 | 1 | |a Kong, Jing |e investigator |4 oth | |
| 700 | 1 | |a Whitehead, Christina |e investigator |4 oth | |
| 700 | 1 | |a Bihari, Shailesh |e investigator |4 oth | |
| 700 | 1 | |a Seven, Aylin |e investigator |4 oth | |
| 700 | 1 | |a Krstevski, Amanda |e investigator |4 oth | |
| 700 | 1 | |a Rodgers, Helen J |e investigator |4 oth | |
| 700 | 1 | |a Millar, Rebecca T |e investigator |4 oth | |
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| 700 | 1 | |a Bailey, Irene M |e investigator |4 oth | |
| 700 | 1 | |a Hanlon, Gabrielle C |e investigator |4 oth | |
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