6533b854fe1ef96bd12af39e
RESEARCH PRODUCT
Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study
Giacomo BellaniJohn G. LaffeyTai PhamFabiana MadottoEddy FanLaurent BrochardAndres EstebanLuciano GattinoniVesna BumbasirevicLise PiquilloudFrank Van HarenAnders LarssonDaniel F. McauleyPhilippe R. BauerYaseen ArabiMarco RanieriMassimo AntonelliGordon D. RubenfeldB. Taylor ThompsonHermann WriggeArthur S. SlutskyAntonio PesentiRios FVan Haren FSottiaux TDepuydt PLora FsAzevedo LcFan EBugedo GQiu HGonzalez MSilesky JCerny VNielsen JJibaja MPham TWrigge HMatamis DRanero JlAmin PHashemian SmClarkson KBellani GKurahashi KVillagomez AZeggwagh AaHeunks LmLaake JhPalo JeDo Vale Fernandes ASandesc DArabi YBumbasierevic VNin NLorente JaLarsson APiquilloud LAbroug FMcauley DfMcnamee LHurtado JBajwa EDémpaire GFrancois GmSula HNunci LCani AZazu ADellera CInsaurralde CsAlejandro RvDaldin JVinzio MFernandez RoCardonnet LpBettini LrBisso McOsman EmSetten MgLovazzano PAlvarez JVillar VPozo NcGrubissich NPlotnikow GaVasquez DnIlutovich STiribelli NChena APellegrini CaSaenz MgEstenssoro EBrizuela MGianinetto HGomez PeCerrato ViBezzi MgBorello SaLoiacono FaFernandez AmKnowles SReynolds CInskip DmMiller JjKong JWhitehead CBihari SSeven AKrstevski ARodgers HjMillar RtMckenna TeBailey ImHanlon GcAneman ALynch JmAzad RNeal JWoods PwRoberts BlKol MrWong HsRiss KcStaudinger TWittebole XBerghe CBulpa PaDive 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MaleARDSprocedureblood oxygen tensionCritical Care and Intensive Care MedicineSeverity of Illness Indexlaw.invention0302 clinical medicinelawHospital MortalityRespiratory Distress SyndromeAcute respiratory distress syndromeadult respiratory distress syndromeMiddle AgedIntensive care unitIntensive Care Unitsmedicine.anatomical_structureTreatment Outcomepriority journalpositive end expiratory pressureNoninvasive ventilationdisease severityFemaletreatment outcome AgedNoninvasive ventilationprospective studyHumanAdultPulmonary and Respiratory Medicinemedicine.medical_specialtycohort analysiIntensive Care Unitdisease classificationAcute respiratory distressArticleNO03 medical and health sciencesacute respiratory distress syndrome; noninvasive ventilationlength of staySeverity of illnessSettore MED/41 - ANESTESIOLOGIAmedicineSequential Organ Failure Assessment ScoreHumansIn patientAcute respiratory distress syndrome; Noninvasive ventilation; Aged; Female; Hospital Mortality; Humans; Intensive Care Units; Male; Middle Aged; Respiratory Distress Syndrome Adult; Severity of Illness Index; Treatment Outcome; Noninvasive Ventilation; Pulmonary and Respiratory Medicine; Critical Care and Intensive Care MedicineIntensive care medicineoutcome assessmentAgedLungbusiness.industryRespiratory Distress Syndrome Adult030208 emergency & critical care medicinemedicine.diseasemajor clinical studymortalityrespiratory tract diseasesbreathing ratemulticenter study030228 respiratory systemincidenceObservational studyobservational studybusinessAcute respiratory distress syndrome; Noninvasive ventilation;description
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2016-10-19 |