Giacomo Bellani1,2, John G Laffey3,4,5,6,7,8, Tài Pham9,10,11, Fabiana Madotto12, Eddy Fan8,13,14,15, Laurent Brochard4,8,14,15, Andres Esteban16, Luciano Gattinoni17, Vesna Bumbasirevic18,19, Lise Piquilloud20,21, Frank van Haren22,23, Anders Larsson24, Daniel F McAuley25,26, Philippe R Bauer27, Yaseen M Arabi28,29, Marco Ranieri30, Massimo Antonelli31, Gordon D Rubenfeld8,14,32, B Taylor Thompson33, Hermann Wrigge34, Arthur S Slutsky5,8,14, Antonio Pesenti35,36. 1. 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 2. 2 Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 3. 3 Department of Anesthesia. 4. 4 Department of Critical Care Medicine, and. 5. 5 Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 6. 6 Department of Anesthesia. 7. 7 Department of Physiology. 8. 8 Interdepartmental Division of Critical Care Medicine. 9. 9 Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France. 10. 10 Unité Mixte de Recherche 1153, Inserm, Sorbonne Paris Cité, Epidémiologie Clinique et Statistiques, pour la Recherche en Santé Team, Université Paris Diderot, Paris, France. 11. 11 Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, France. 12. 12 Research Centre on Public Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. 13. 13 Institute of Health Policy, Management and Evaluation, and. 14. 14 Department of Medicine, University of Toronto, Toronto, Canada. 15. 15 Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada. 16. 16 Hospital Universitario de Getafe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain. 17. 17 Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany. 18. 18 School of Medicine, University of Belgrade, Belgrade, Serbia. 19. 19 Department of Anesthesia and Intensive Care, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia. 20. 20 Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland. 21. 21 Department of Medical Intensive Care, University Hospital of Angers, Angers, France. 22. 22 Intensive Care Unit, The Canberra Hospital, Canberra, Australia. 23. 23 Australian National University, Canberra, Australia. 24. 24 Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 25. 25 Centre for Experimental Medicine, Queen's University of Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast, United Kingdom. 26. 26 Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom. 27. 27 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. 28. 28 King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 29. 29 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 30. 30 Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Sapienza Università di Roma, Roma, Italy. 31. 31 Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore-Fondazione Policlinico Universitario A. Gemelli, Roma, Italy. 32. 32 Sunnybrook Health Sciences Center, Toronto, Canada. 33. 33 Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. 34. 34 Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany. 35. 35 Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione Istituto di ricovero e Cura a Carattere Scientifico Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy; and. 36. 36 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
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: 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. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).
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. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).
Authors: Samir Jaber; Giacomo Bellani; Lluis Blanch; Alexandre Demoule; Andrés Esteban; Luciano Gattinoni; Claude Guérin; Nicholas Hill; John G Laffey; Salvatore Maurizio Maggiore; Jordi Mancebo; Paul H Mayo; Jarrod M Mosier; Paolo Navalesi; Michael Quintel; Jean Louis Vincent; John J Marini Journal: Intensive Care Med Date: 2017-08-07 Impact factor: 17.440
Authors: Bruno L Ferreyro; Federico Angriman; Laveena Munshi; Lorenzo Del Sorbo; Niall D Ferguson; Bram Rochwerg; Michelle J Ryu; Refik Saskin; Hannah Wunsch; Bruno R da Costa; Damon C Scales Journal: JAMA Date: 2020-07-07 Impact factor: 56.272