Abhijit Duggal1, Emanuele Rezoagli2, Tài Pham3, Bairbre A McNicholas4, Eddy Fan5, Giacomo Bellani6, Gordon Rubenfeld7, Antonio M Pesenti8, John G Laffey9. 1. Department of Critical Care, Respiratory Institute, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH. 2. Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 3. Department of Critical Care Medicine and Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 4. Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland; Nephrology Services, Galway University Hospitals, SAOLTA University Healthcare Group, Galway, Ireland; Service de médecine Intensive-réanimation, AP-HP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France. 5. Department of Medicine, University Health Network and Mount Sinai Hospital, and Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 6. Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 7. Interdepartmental Division of Critical Care Medicine, University of Toronto and Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada. 8. Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. 9. Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, Biomedical Sciences Building, National University of Ireland Galway, Galway, Ireland; Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, and School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. Electronic address: john.laffey@nuigalway.ie.
Abstract
BACKGROUND: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. RESEARCH QUESTION: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (Pao2/Fio2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. STUDY DESIGN AND METHODS: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). RESULTS: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. INTERPRETATION: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov.
BACKGROUND: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. RESEARCH QUESTION: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (Pao2/Fio2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. STUDY DESIGN AND METHODS: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). RESULTS: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. INTERPRETATION: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov.
Authors: Chad H Hochberg; Kevin J Psoter; Sarina K Sahetya; Eric P Nolley; Shakir Hossen; William Checkley; Meeta P Kerlin; Michelle N Eakin; David N Hager Journal: Crit Care Explor Date: 2022-05-13
Authors: Lorenzo Berra; Emanuele Rezoagli; Davide Signori; Aurora Magliocca; Kei Hayashida; Jan A Graw; Rajeev Malhotra; Giacomo Bellani Journal: Intensive Care Med Exp Date: 2022-06-27
Authors: Brijesh V Patel; Shlomi Haar; Rhodri Handslip; John R Prowle; Zudin Puthucheary; Aldo A Faisal; Chaiyawan Auepanwiriyakul; Teresa Mei-Ling Lee; Sunil Patel; J Alex Harston; Feargus Hosking-Jervis; Donna Kelly; Barnaby Sanderson; Barbara Borgatta; Kate Tatham; Ingeborg Welters; Luigi Camporota; Anthony C Gordon; Matthieu Komorowski; David Antcliffe Journal: Intensive Care Med Date: 2021-05-11 Impact factor: 17.440
Authors: Kamal Fani; Mehdi Ghahremani; Mohammad Fathi; Nilofar Massoudi; Sasan Tavana; Navid Nooraee; Nasser Malekpour Alamdari; Sara Besharat; Arash Najafi Abrandabadi; Ali Pirsalehi; Mohammad Ali Khabiri Khatiri; Maryam Amini Pouya; Samira Rajaei; Ali Dabbagh Journal: Iran J Pharm Res Date: 2021 Impact factor: 1.696
Authors: Ana C Monteiro; Rajat Suri; Iheanacho O Emeruwa; Robert J Stretch; Roxana Y Cortes-Lopez; Alexander Sherman; Catherine C Lindsay; Jennifer A Fulcher; David Goodman-Meza; Anil Sapru; Russell G Buhr; Steven Y Chang; Tisha Wang; Nida Qadir Journal: PLoS One Date: 2020-12-22 Impact factor: 3.752