Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

Tai Pham; Antonio Pesenti; Giacomo Bellani; Gordon Rubenfeld; Eddy Fan; Guillermo Bugedo; Jose Angel Lorente; Antero do Vale Fernandes; Frank Van Haren; Alejandro Bruhn; Fernando Rios; Andres Esteban; Luciano Gattinoni; Anders Larsson; Daniel F. McAuley; Marco Ranieri; B. Taylor Thompson; Hermann Wrigge; Laurent J. Brochard; John G. Laffey

doi:10.1183/13993003.03317-2020

Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

Tai Pham, Antonio Pesenti, Giacomo Bellani, Gordon Rubenfeld, Eddy Fan, Guillermo Bugedo, Jose Angel Lorente, Antero do Vale Fernandes, Frank Van Haren, Alejandro Bruhn, Fernando Rios, Andres Esteban, Luciano Gattinoni, Anders Larsson, Daniel F. McAuley, Marco Ranieri, B. Taylor Thompson, Hermann Wrigge, Laurent J. Brochard, John G. Laffey

Physiotherapy

Research output: Contribution to journal › Article › peer-review

37 Citations (Scopus)

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.

Original language	English
Article number	2003317
Pages (from-to)	1-49
Number of pages	49
Journal	European Respiratory Journal
Volume	57
Issue number	6
DOIs	https://doi.org/10.1183/13993003.03317-2020
Publication status	Published - 1 Jun 2021

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10.1183/13993003.03317-2020

https://air.unimi.it/bitstream/2434/808913/2/515_Pham%20%20Eur%20Respir%20J%2013993003.03317-2020.full.pdf

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Pham, T., Pesenti, A., Bellani, G., Rubenfeld, G., Fan, E., Bugedo, G., Lorente, J. A., Fernandes, A. D. V., Van Haren, F., Bruhn, A., Rios, F., Esteban, A., Gattinoni, L., Larsson, A., McAuley, D. F., Ranieri, M., Thompson, B. T., Wrigge, H., Brochard, L. J., & Laffey, J. G. (2021). Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study. European Respiratory Journal, 57(6), 1-49. [2003317]. https://doi.org/10.1183/13993003.03317-2020

@article{32b19c1b8dcf43f2a604981af63c55c5,

title = "Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study",

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.",

author = "Tai Pham and Antonio Pesenti and Giacomo Bellani and Gordon Rubenfeld and Eddy Fan and Guillermo Bugedo and Lorente, {Jose Angel} and Fernandes, {Antero do Vale} and {Van Haren}, Frank and Alejandro Bruhn and Fernando Rios and Andres Esteban and Luciano Gattinoni and Anders Larsson and McAuley, {Daniel F.} and Marco Ranieri and Thompson, {B. Taylor} and Hermann Wrigge and Brochard, {Laurent J.} and Laffey, {John G.}",

note = "Funding Information: Support statement: This work was supported by the European Society of Intensive Care Medicine. Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: Conflict of interest: T. Pham has nothing to disclose. A. Pesenti reports personal fees from Maquet, Novalung/Xenios, Baxter, Gilead and Boehringer Ingelheim, outside the submitted work. G. Bellani reports grants and personal fees from Draeger Medical, personal fees from Getinge, Hamilton, GE Healthcare, Dimar SRL, Intersurgical and Flowmeter SPA, outside the submitted work. G. Rubenfeld has nothing to disclose. E. Fan reports personal fees from ALung Technologies, Getinge and MC3 Cardiopulmonary, grants, personal fees and non-financial support from Fresenius Medical Care, outside the submitted work. G. Bugedo has nothing to disclose. J.A. Lorente has nothing to disclose. A.D. V. Fernandes has nothing to disclose. F. Van Haren has nothing to disclose. A. Bruhn has nothing to disclose. F. Rios has nothing to disclose. A. Esteban has nothing to disclose. L. Gattinoni has nothing to disclose. A. Larsson reports grants from the Swedish Heart and Lung Foundation, during the conduct of the study. D.F. McAuley reports personal fees from consultancy for GlaxoSmithKline, Boehringer Ingelheim and Bayer, outside the submitted work; in addition, his institution has received funds from grants from the UK NIHR, Wellcome Trust, Innovate UK, NI HSC R&D Division, NI Chest Heart and Stroke, and MRC; is one of four named inventors on a patent US8962032 covering the use of sialic acid-bearing nanoparticles as anti-inflammatory agents issued to his institution, The Queen{\textquoteright}s University of Belfast (http://www.google.com/patents/US8962032); and is a Director of Research for the Intensive Care Society and NIHR EME Programme Director. M. Ranieri has nothing to disclose. B.T. Thompson reports personal fees from Bayer, Thetis and Novartis, outside the submitted work. H. Wrigge reports personal fees for consultancy from Dr{\"a}ger Medical, personal fees for advisory board work from Liberate Medical, grants and personal fees for lectures from InfectoPharm, personal fees for lectures from MSD and GE, outside the submitted work. L.J. Brochard reports grants from Medtronic Covidien, grants and non-financial support from Fisher Paykel, non-financial support from Air Liquide, Sentec and Philips, other (patent) from General Electric, outside the submitted work. J.G. Laffey reports grants and personal fees from Baxter, grants and non-financial support from Aerogen and Factor Biosciences, outside the submitted work. Publisher Copyright: {\textcopyright} 2021 European Respiratory Society. All rights reserved.",

year = "2021",

month = jun,

day = "1",

doi = "10.1183/13993003.03317-2020",

language = "English",

volume = "57",

pages = "1--49",

journal = "European Respiratory Journal",

issn = "0903-1936",

publisher = "European Respiratory Society",

number = "6",

}

Pham, T, Pesenti, A, Bellani, G, Rubenfeld, G, Fan, E, Bugedo, G, Lorente, JA, Fernandes, ADV, Van Haren, F, Bruhn, A, Rios, F, Esteban, A, Gattinoni, L, Larsson, A, McAuley, DF, Ranieri, M, Thompson, BT, Wrigge, H, Brochard, LJ & Laffey, JG 2021, 'Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study', European Respiratory Journal, vol. 57, no. 6, 2003317, pp. 1-49. https://doi.org/10.1183/13993003.03317-2020

TY - JOUR

T1 - Outcome of acute hypoxaemic respiratory failure

T2 - insights from the LUNG SAFE Study

AU - Pham, Tai

AU - Pesenti, Antonio

AU - Bellani, Giacomo

AU - Rubenfeld, Gordon

AU - Fan, Eddy

AU - Bugedo, Guillermo

AU - Lorente, Jose Angel

AU - Fernandes, Antero do Vale

AU - Van Haren, Frank

AU - Bruhn, Alejandro

AU - Rios, Fernando

AU - Esteban, Andres

AU - Gattinoni, Luciano

AU - Larsson, Anders

AU - McAuley, Daniel F.

AU - Ranieri, Marco

AU - Thompson, B. Taylor

AU - Wrigge, Hermann

AU - Brochard, Laurent J.

AU - Laffey, John G.

N1 - Funding Information: Support statement: This work was supported by the European Society of Intensive Care Medicine. Funding information for this article has been deposited with the Crossref Funder Registry. Funding Information: Conflict of interest: T. Pham has nothing to disclose. A. Pesenti reports personal fees from Maquet, Novalung/Xenios, Baxter, Gilead and Boehringer Ingelheim, outside the submitted work. G. Bellani reports grants and personal fees from Draeger Medical, personal fees from Getinge, Hamilton, GE Healthcare, Dimar SRL, Intersurgical and Flowmeter SPA, outside the submitted work. G. Rubenfeld has nothing to disclose. E. Fan reports personal fees from ALung Technologies, Getinge and MC3 Cardiopulmonary, grants, personal fees and non-financial support from Fresenius Medical Care, outside the submitted work. G. Bugedo has nothing to disclose. J.A. Lorente has nothing to disclose. A.D. V. Fernandes has nothing to disclose. F. Van Haren has nothing to disclose. A. Bruhn has nothing to disclose. F. Rios has nothing to disclose. A. Esteban has nothing to disclose. L. Gattinoni has nothing to disclose. A. Larsson reports grants from the Swedish Heart and Lung Foundation, during the conduct of the study. D.F. McAuley reports personal fees from consultancy for GlaxoSmithKline, Boehringer Ingelheim and Bayer, outside the submitted work; in addition, his institution has received funds from grants from the UK NIHR, Wellcome Trust, Innovate UK, NI HSC R&D Division, NI Chest Heart and Stroke, and MRC; is one of four named inventors on a patent US8962032 covering the use of sialic acid-bearing nanoparticles as anti-inflammatory agents issued to his institution, The Queen’s University of Belfast (http://www.google.com/patents/US8962032); and is a Director of Research for the Intensive Care Society and NIHR EME Programme Director. M. Ranieri has nothing to disclose. B.T. Thompson reports personal fees from Bayer, Thetis and Novartis, outside the submitted work. H. Wrigge reports personal fees for consultancy from Dräger Medical, personal fees for advisory board work from Liberate Medical, grants and personal fees for lectures from InfectoPharm, personal fees for lectures from MSD and GE, outside the submitted work. L.J. Brochard reports grants from Medtronic Covidien, grants and non-financial support from Fisher Paykel, non-financial support from Air Liquide, Sentec and Philips, other (patent) from General Electric, outside the submitted work. J.G. Laffey reports grants and personal fees from Baxter, grants and non-financial support from Aerogen and Factor Biosciences, outside the submitted work. Publisher Copyright: © 2021 European Respiratory Society. All rights reserved.

PY - 2021/6/1

Y1 - 2021/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85108123728&partnerID=8YFLogxK

U2 - 10.1183/13993003.03317-2020

DO - 10.1183/13993003.03317-2020

M3 - Article

SN - 0903-1936

VL - 57

SP - 1

EP - 49

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 6

M1 - 2003317

ER -

Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study

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