학술논문
Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study.
Document Type
Academic Journal
Author
Pham T; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Heath Toronto, Toronto, ON, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; 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.; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Equipe d'Epidémiologie respiratoire intégrative, CESP, Villejuif, France.; Pesenti A; Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.; Bellani G; School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.; Dept of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.; Rubenfeld G; Interdepartmental Division of Critical Care Medicine, University of Toronto and Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada.; Fan E; Dept of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.; Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.; Bugedo G; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; Lorente JA; Critical Care Dept, Hospital Universitario de Getafe, Madrid, Spain.; CIBER Enfermedades Respiratorias, Madrid, Spain.; Universidad Europea, Madrid, Spain.; Fernandes ADV; Serviço de Medicina Intensiva, Hospital Garcia de Orta, E.P.E, Almada, Portugal.; Van Haren F; Intensive Care Unit, Canberra Hospital, Garran, Australia.; Australian National University Medical School, Canberra Hospital, Garran, Australia.; University of Canberra, Faculty of Health, Canberra, Australia.; Bruhn A; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; Rios F; Intensive Care Unit, Hospital Nacional Alejandro Posadas, Buenos Aires, Argentina.; Esteban A; Hospital Universitario de Getafe, Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.; Gattinoni L; University of Göttingen, Dept of Anaesthesiology, Emergency and Intensive Care Medicine, Göttingen, Germany.; Larsson A; Dept of Medical Sciences, Uppsala University, Uppsala, Sweden.; McAuley DF; Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK.; Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK.; Ranieri M; Alma Mater Studiorum-Università di Bologna, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Bologna, Italy.; Thompson BT; Massachusetts General Hospital, Harvard School of Medicine, Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Boston, MA, USA.; Wrigge H; Dept of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.; Dept of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital Halle, Halle, Germany.; Brochard LJ; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Heath Toronto, Toronto, ON, Canada Laurent.brochard@unityhealth.to.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Co-senior authors.; Laffey JG; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Heath Toronto, Toronto, ON, Canada.; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.; Dept of Anesthesia, St Michael's Hospital and University of Toronto, Toronto, ON, Canada.; School of Medicine, and Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.; Co-senior authors.
Source
Publisher: European Respiratory Society Country of Publication: England NLM ID: 8803460 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1399-3003 (Electronic) Linking ISSN: 09031936 NLM ISO Abbreviation: Eur Respir J Subsets: MEDLINE
Subject
Language
English
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 cmH2 O. 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.
Competing Interests: Conflict of interest: T. Pham has nothing to disclose. Conflict of interest: A. Pesenti reports personal fees from Maquet, Novalung/Xenios, Baxter, Gilead and Boehringer Ingelheim, outside the submitted work. Conflict of interest: 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. Conflict of interest: G. Rubenfeld has nothing to disclose. Conflict of interest: 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. Conflict of interest: G. Bugedo has nothing to disclose. Conflict of interest: J.A. Lorente has nothing to disclose. Conflict of interest: A.D.V. Fernandes has nothing to disclose. Conflict of interest: F. Van Haren has nothing to disclose. Conflict of interest: A. Bruhn has nothing to disclose. Conflict of interest: F. Rios has nothing to disclose. Conflict of interest: A. Esteban has nothing to disclose. Conflict of interest: L. Gattinoni has nothing to disclose. Conflict of interest: A. Larsson reports grants from the Swedish Heart and Lung Foundation, during the conduct of the study. Conflict of interest: 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. Conflict of interest: M. Ranieri has nothing to disclose. Conflict of interest: B.T. Thompson reports personal fees from Bayer, Thetis and Novartis, outside the submitted work. Conflict of interest: 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. Conflict of interest: 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. Conflict of interest: J.G. Laffey reports grants and personal fees from Baxter, grants and non-financial support from Aerogen and Factor Biosciences, outside the submitted work.
(Copyright ©ERS 2021.)
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 cmH
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.
Competing Interests: Conflict of interest: T. Pham has nothing to disclose. Conflict of interest: A. Pesenti reports personal fees from Maquet, Novalung/Xenios, Baxter, Gilead and Boehringer Ingelheim, outside the submitted work. Conflict of interest: 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. Conflict of interest: G. Rubenfeld has nothing to disclose. Conflict of interest: 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. Conflict of interest: G. Bugedo has nothing to disclose. Conflict of interest: J.A. Lorente has nothing to disclose. Conflict of interest: A.D.V. Fernandes has nothing to disclose. Conflict of interest: F. Van Haren has nothing to disclose. Conflict of interest: A. Bruhn has nothing to disclose. Conflict of interest: F. Rios has nothing to disclose. Conflict of interest: A. Esteban has nothing to disclose. Conflict of interest: L. Gattinoni has nothing to disclose. Conflict of interest: A. Larsson reports grants from the Swedish Heart and Lung Foundation, during the conduct of the study. Conflict of interest: 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. Conflict of interest: M. Ranieri has nothing to disclose. Conflict of interest: B.T. Thompson reports personal fees from Bayer, Thetis and Novartis, outside the submitted work. Conflict of interest: 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. Conflict of interest: 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. Conflict of interest: J.G. Laffey reports grants and personal fees from Baxter, grants and non-financial support from Aerogen and Factor Biosciences, outside the submitted work.
(Copyright ©ERS 2021.)