uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study
Show others and affiliations
2016 (English)In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, no 12, 1865-1876 p.Article in journal (Refereed) Published
Abstract [en]

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 PaO2/FiO2 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.

Place, publisher, year, edition, pages
2016. Vol. 42, no 12, 1865-1876 p.
Keyword [en]
Acute respiratory distress syndrome, Positive end-expiratory pressure, Patient outcome, Driving pressure, Peak inspiratory pressure
National Category
Anesthesiology and Intensive Care Respiratory Medicine and Allergy
URN: urn:nbn:se:uu:diva-307916DOI: 10.1007/s00134-016-4571-5ISI: 000387846500006PubMedID: 27757516OAI: oai:DiVA.org:uu-307916DiVA: diva2:1048835
Available from: 2016-11-22 Created: 2016-11-22 Last updated: 2017-01-05Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Larsson, Anders
By organisation
Anaesthesiology and Intensive CareHedenstierna laboratory
In the same journal
Intensive Care Medicine
Anesthesiology and Intensive CareRespiratory Medicine and Allergy

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 56 hits
ReferencesLink to record
Permanent link

Direct link