Tài Pham1,2,3,4, Antonio Pesenti5,6, Giacomo Bellani7,8, Gordon Rubenfeld9, Eddy Fan10,11, Guillermo Bugedo12, José Angel Lorente13,14,15, Antero do Vale Fernandes16, Frank Van Haren17,18,19, Alejandro Bruhn12, Fernando Rios20, Andres Esteban21, Luciano Gattinoni22, Anders Larsson23, Daniel F McAuley24,25, Marco Ranieri26, B Taylor Thompson27, Hermann Wrigge28,29, Laurent J Brochard30,2,31, John G Laffey1,2,32,33,31. 1. Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Heath Toronto, Toronto, ON, Canada. 2. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. 3. Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de recherche clinique CARMAS, Le Kremlin-Bicêtre, France. 4. Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Equipe d'Epidémiologie respiratoire intégrative, CESP, Villejuif, France. 5. Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy. 6. Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy. 7. School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. 8. Dept of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy. 9. Interdepartmental Division of Critical Care Medicine, University of Toronto and Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada. 10. Dept of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. 11. Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. 12. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. 13. Critical Care Dept, Hospital Universitario de Getafe, Madrid, Spain. 14. CIBER Enfermedades Respiratorias, Madrid, Spain. 15. Universidad Europea, Madrid, Spain. 16. Serviço de Medicina Intensiva, Hospital Garcia de Orta, E.P.E, Almada, Portugal. 17. Intensive Care Unit, Canberra Hospital, Garran, Australia. 18. Australian National University Medical School, Canberra Hospital, Garran, Australia. 19. University of Canberra, Faculty of Health, Canberra, Australia. 20. Intensive Care Unit, Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina. 21. Hospital Universitario de Getafe, Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 22. University of Göttingen, Dept of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen, Germany. 23. Dept of Medical Sciences, Uppsala University, Uppsala, Sweden. 24. Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK. 25. Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK. 26. Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy. 27. Massachusetts General Hospital, Harvard School of Medicine, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Boston, MA, USA. 28. Dept of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany. 29. Dept of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany. 30. Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Heath Toronto, Toronto, ON, Canada Laurent.brochard@unityhealth.to. 31. Co-senior authors. 32. Dept of Anesthesia, St Michael's Hospital and University of Toronto, Toronto, ON, Canada. 33. School of Medicine, and Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
Abstract
BACKGROUND: Current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS). METHODS: An international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure of ≥5 cmH2O. ICU prevalence, causes of hypoxaemia, hospital survival and factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared. FINDINGS: 12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (CHF; 8.2%). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1% versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality, but similar adjusted mortality compared to those with ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only two quadrants involved. INTERPRETATION: More than one-third of patients receiving mechanical ventilation have hypoxaemia and new infiltrates with a hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.
BACKGROUND: Current incidence and outcome of patients with acute hypoxaemic respiratory failure requiring mechanical ventilation in the intensive care unit (ICU) are unknown, especially for patients not meeting criteria for acute respiratory distress syndrome (ARDS). METHODS: An international, multicentre, prospective cohort study of patients presenting with hypoxaemia early in the course of mechanical ventilation, conducted during four consecutive weeks in the winter of 2014 in 459 ICUs from 50 countries (LUNG SAFE). Patients were enrolled with arterial oxygen tension/inspiratory oxygen fraction ratio ≤300 mmHg, new pulmonary infiltrates and need for mechanical ventilation with a positive end-expiratory pressure of ≥5 cmH2O. ICU prevalence, causes of hypoxaemia, hospital survival and factors associated with hospital mortality were measured. Patients with unilateral versus bilateral opacities were compared. FINDINGS: 12 906 critically ill patients received mechanical ventilation and 34.9% with hypoxaemia and new infiltrates were enrolled, separated into ARDS (69.0%), unilateral infiltrate (22.7%) and congestive heart failure (CHF; 8.2%). The global hospital mortality was 38.6%. CHF patients had a mortality comparable to ARDS (44.1% versus 40.4%). Patients with unilateral-infiltrate had lower unadjusted mortality, but similar adjusted mortality compared to those with ARDS. The number of quadrants on chest imaging was associated with an increased risk of death. There was no difference in mortality comparing patients with unilateral-infiltrate and ARDS with only two quadrants involved. INTERPRETATION: More than one-third of patients receiving mechanical ventilation have hypoxaemia and new infiltrates with a hospital mortality of 38.6%. Survival is dependent on the degree of pulmonary involvement whether or not ARDS criteria are reached.
Authors: Neha A Sathe; Leila R Zelnick; Carmen Mikacenic; Eric D Morrell; Pavan K Bhatraju; J Brennan McNeil; Susanna Kosamo; Catherine L Hough; W Conrad Liles; Lorraine B Ware; Mark M Wurfel Journal: Crit Care Date: 2021-09-15 Impact factor: 19.334
Authors: Jesús Villar; Juan M Mora-Ordoñez; Juan A Soler; Fernando Mosteiro; Anxela Vidal; Alfonso Ambrós; Lorena Fernández; Isabel Murcia; Belén Civantos; Miguel A Romera; Adrián Mira; Francisco J Díaz-Domínguez; Dácil Parrilla; J Francisco Martínez-Carmona; Domingo Martínez; Lidia Pita-García; Denis Robaglia; Ana Bueno-González; Jesús Sánchez-Ballesteros; Ángel E Pereyra; Mónica Hernández; Carlos Chamorro-Jambrina; Pilar Cobeta; Raúl I González-Luengo; Raquel Montiel; Leonor Nogales; M Mar Fernández; Blanca Arocas; Álvaro Valverde-Montoro; Ana M Del Saz-Ortiz; Victoria Olea-Jiménez; José M Añón; Pedro Rodríguez-Suárez; Rosa L Fernández; Cristina Fernández; Tamas Szakmany; Jesús M González-Martín; Carlos Ferrando; Robert M Kacmarek; Arthur S Slutsky Journal: Crit Care Explor Date: 2022-04-29
Authors: Samuel M Brown; Ithan D Peltan; Christina Barkauskas; Angela J Rogers; Virginia Kan; Annetine Gelijns; B Taylor Thompson Journal: Ann Am Thorac Soc Date: 2021-12
Authors: Domenico Luca Grieco; Salvatore Maurizio Maggiore; Oriol Roca; Elena Spinelli; Bhakti K Patel; Arnaud W Thille; Carmen Sílvia V Barbas; Marina Garcia de Acilu; Salvatore Lucio Cutuli; Filippo Bongiovanni; Marcelo Amato; Jean-Pierre Frat; Tommaso Mauri; John P Kress; Jordi Mancebo; Massimo Antonelli Journal: Intensive Care Med Date: 2021-07-07 Impact factor: 17.440