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Non-invasive Ventilation of Patients with ARDS: Insights from the LUNG SAFE Study.
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2016 (English)In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Non-invasive ventilation (NIV) is increasingly used in patients with Acute Respiratory Distress Syndrome (ARDS). Whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful is unknown. The evidence supporting NIV use in patients with ARDS remains relatively sparse.

METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study described the management of patients with ARDS. This sub-study 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.

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 (HR 1.446; [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 mmHg.

CONCLUSIONS: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV appears to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mmHg. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02010073.

Place, publisher, year, edition, pages
2016.
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Medical and Health Sciences
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URN: urn:nbn:se:uu:diva-307917DOI: 10.1164/rccm.201606-1306OCPubMedID: 27753501OAI: oai:DiVA.org:uu-307917DiVA: diva2:1048836
Available from: 2016-11-22 Created: 2016-11-22 Last updated: 2016-11-22

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Larsson, Anders
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Anaesthesiology and Intensive CareHedenstierna laboratory
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