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Title: Resolved versus confirmed ARDS after 24 h: insights from the LUNG SAFE study
Authors: Fabiana Madotto
Tài Pham
Giacomo Bellani
Lieuwe D. Bos
Fabienne D. Simonis
Eddy Fan
Antonio Artigas
Laurent Brochard
Marcus J. Schultz
John G. Laffey
Antonio Pesenti
Andres Esteban
Luciano Gattinoni
Frank van Haren
Anders Larsson
Daniel F. McAuley
Marco Ranieri
Gordon Rubenfeld
B. Taylor Thompson
Hermann Wrigge
Arthur S. Slutsky
Fernando Rios
Frank Van Haren
T. Sottiaux
P. Depuydt
Fredy S. Lora
Luciano Cesar Azevedo
Eddy Fan
Guillermo Bugedo
Haibo Qiu
Marcos Gonzalez
Juan Silesky
Vladimir Cerny
Jonas Nielsen
Manuel Jibaja
Dimitrios Matamis
Jorge Luis Ranero
Pravin Amin
S. M. Hashemian
Kevin Clarkson
Kiyoyasu Kurahashi
Asisclo Villagomez
Amine Ali Zeggwagh
Leo M. Heunks
Jon Henrik Laake
Jose Emmanuel Palo
Antero do Vale Fernandes
Dorel Sandesc
Yaasen Arabi
Vesna Bumbasierevic
Nicolas Nin
Jose A. Lorente
Anders Larsson
Lise Piquilloud
Fekri Abroug
Daniel F. McAuley
Lia McNamee
Javier Hurtado
Ed Bajwa
Gabriel Démpaire
Hektor Sula
Lordian Nunci
Alma Cani
Alan Zazu
Christian Dellera
Risso V. Alejandro
Julio Daldin
Mauricio Vinzio
Ruben O. Fernandez
Luis P. Cardonnet
Lisandro R. Bettini
Mariano Carboni Bisso
Emilio M. Osman
Mariano G. Setten
Pablo Lovazzano
Javier Alvarez
Veronica Villar
Norberto C. Pozo
Nicolas Grubissich
Gustavo A. Plotnikow
Daniela N. Vasquez
Santiago Ilutovich
Norberto Tiribelli
Ariel Chena
Carlos A. Pellegrini
María G. Saenz
Elisa Estenssoro
Matias Brizuela
Hernan Gianinetto
Pablo E. Gomez
Valeria I. Cerrato
Marco G. Bezzi
Silvina A. Borello
Flavia A. Loiacono
Adriana M. Fernandez
Serena Knowles
Claire Reynolds
Deborah M. Inskip
Jennene J. Miller
Li Ka Shing Knowledge Institute
Universitat Autònoma de Barcelona
Saint Michael's Hospital University of Toronto
University of Toronto
University Health Network University of Toronto
Azienda Ospedaliera San Gerardo Monza
Mahidol University
University of Milano - Bicocca
National University of Ireland Galway
Amsterdam UMC - University of Amsterdam
Keywords: Medicine
Issue Date: 1-May-2018
Citation: Intensive Care Medicine. Vol.44, No.5 (2018), 564-577
Abstract: © 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM. 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: NCT02010073.
ISSN: 14321238
Appears in Collections:Scopus 2018

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