TY - JOUR
T1 - Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome
T2 - Insights from the LUNG SAFE Study
AU - Bellani, Giacomo
AU - Laffey, John G.
AU - Pham, Tai
AU - Madotto, Fabiana
AU - Fan, Eddy
AU - Brochard, Laurent
AU - Esteban, Andres
AU - Gattinoni, Luciano
AU - Bumbasirevic, Vesna
AU - Piquilloud, Lise
AU - Van Haren, Frank
AU - Larsson, Anders
AU - McAuley, Daniel F.
AU - Bauer, Philippe R.
AU - Arabi, Yaseen M.
AU - Ranieri, Marco
AU - Antonelli, Massimo
AU - Rubenfeld, Gordon D.
AU - Taylor Thompson, B.
AU - Wrigge, Hermann
AU - Slutsky, Arthur S.
AU - Pesenti, Antonio
AU - on behalf of the LUNG SAFE Investigators and the ESICM Trials Group
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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: TheLUNGSAFE(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. MeasurementsandMain Results:Of2,813 patients with ARDS,436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnosticcriteria.Classification of ARDS severity based on PaO2/FIO2ratio 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.
AB - 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: TheLUNGSAFE(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. MeasurementsandMain Results:Of2,813 patients with ARDS,436 (15.5%) were managed with NIV on Days 1 and 2 following fulfillment of diagnosticcriteria.Classification of ARDS severity based on PaO2/FIO2ratio 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.
KW - Acute respiratory distress syndrome
KW - Noninvasive ventilation
UR - http://www.scopus.com/inward/record.url?scp=85008690467&partnerID=8YFLogxK
U2 - 10.1164/rccm.201606-1306OC
DO - 10.1164/rccm.201606-1306OC
M3 - Article
C2 - 27753501
AN - SCOPUS:85008690467
SN - 1073-449X
VL - 195
SP - 67
EP - 77
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 1
ER -