Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study

LUNG SAFE Investigators, ESICM Trials Group

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

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: TheLUNGSAFE(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. MeasurementsandMain Results:Of2,813 patients with ARDS,436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnosticcriteria.Classification of ARDS severity based on PaO2/FIO2ratio 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.

Original languageEnglish
Pages (from-to)67-77
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume195
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Noninvasive Ventilation
Adult Respiratory Distress Syndrome
Intensive Care Units
Hospital Mortality
Mortality
Severe Acute Respiratory Syndrome
Berlin
Respiratory Insufficiency

Keywords

  • Acute respiratory distress syndrome
  • Noninvasive ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome : Insights from the LUNG SAFE Study. / LUNG SAFE Investigators; ESICM Trials Group.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 195, No. 1, 01.01.2017, p. 67-77.

Research output: Contribution to journalArticle

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title = "Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study",
abstract = "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: TheLUNGSAFE(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. MeasurementsandMain Results:Of2,813 patients with ARDS,436 (15.5{\%}) were managed with NIV on Days 1 and 2 following fulfillment of diagnosticcriteria.Classification of ARDS severity based on PaO2/FIO2ratio 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.",
keywords = "Acute respiratory distress syndrome, Noninvasive ventilation",
author = "{LUNG SAFE Investigators} and {ESICM Trials Group} and Giacomo Bellani and Laffey, {John G.} and Tai Pham and Fabiana Madotto and Eddy Fan and Laurent Brochard and Andres Esteban and Luciano Gattinoni and Vesna Bumbasirevic and Lise Piquilloud and {Van Haren}, Frank and Anders Larsson and McAuley, {Daniel F.} and Bauer, {Philippe R.} and Arabi, {Yaseen M.} and Marco Ranieri and Massimo Antonelli and Rubenfeld, {Gordon D.} and {Taylor Thompson}, B. and Hermann Wrigge and Slutsky, {Arthur S.} and Antonio Pesenti and F. Rios and T. Sottiaux and P. Depuydt and Lora, {F. S.} and Azevedo, {L. C.} and G. Bugedo and H. Qiu and M. Gonzalez and J. Silesky and V. Cerny and J. Nielsen and M. Jibaja and D. Matamis and Ranero, {J. L.} and P. Amin and Hashemian, {S. M.} and K. Clarkson and K. Kurahashi and A. Villagomez and Zeggwagh, {A. A.} and Heunks, {L. M.} and Laake, {J. H.} and Palo, {J. E.} and {do Vale Fernandes}, A. and D. Sandesc and V. Bumbasierevic and N. Nin and K. Shimizu",
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T1 - Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome

T2 - Insights from the LUNG SAFE Study

AU - LUNG SAFE Investigators

AU - ESICM Trials Group

AU - Bellani, Giacomo

AU - Laffey, John G.

AU - Pham, Tai

AU - Madotto, Fabiana

AU - Fan, Eddy

AU - Brochard, Laurent

AU - Esteban, Andres

AU - Gattinoni, Luciano

AU - Bumbasirevic, Vesna

AU - Piquilloud, Lise

AU - Van Haren, Frank

AU - Larsson, Anders

AU - McAuley, Daniel F.

AU - Bauer, Philippe R.

AU - Arabi, Yaseen M.

AU - Ranieri, Marco

AU - Antonelli, Massimo

AU - Rubenfeld, Gordon D.

AU - Taylor Thompson, B.

AU - Wrigge, Hermann

AU - Slutsky, Arthur S.

AU - Pesenti, Antonio

AU - Rios, F.

AU - Sottiaux, T.

AU - Depuydt, P.

AU - Lora, F. S.

AU - Azevedo, L. C.

AU - Bugedo, G.

AU - Qiu, H.

AU - Gonzalez, M.

AU - Silesky, J.

AU - Cerny, V.

AU - Nielsen, J.

AU - Jibaja, M.

AU - Matamis, D.

AU - Ranero, J. L.

AU - Amin, P.

AU - Hashemian, S. M.

AU - Clarkson, K.

AU - Kurahashi, K.

AU - Villagomez, A.

AU - Zeggwagh, A. A.

AU - Heunks, L. M.

AU - Laake, J. H.

AU - Palo, J. E.

AU - do Vale Fernandes, A.

AU - Sandesc, D.

AU - Bumbasierevic, V.

AU - Nin, N.

AU - Shimizu, K.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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: TheLUNGSAFE(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. MeasurementsandMain Results:Of2,813 patients with ARDS,436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnosticcriteria.Classification of ARDS severity based on PaO2/FIO2ratio 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.

AB - 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: TheLUNGSAFE(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. MeasurementsandMain Results:Of2,813 patients with ARDS,436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnosticcriteria.Classification of ARDS severity based on PaO2/FIO2ratio 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.

KW - Acute respiratory distress syndrome

KW - Noninvasive ventilation

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