Outcome of acute hypoxaemic respiratory failure: insights from the LUNG SAFE Study
Por:
Pham, T, Pesenti, A, Bellani, G, Rubenfeld, G, Fan, E, Bugedo, G, Lorente, JA, Fernandes, AD, 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, Mancebo J., Schomer, Ashley M.
Publicada:
1 jun 2021
Resumen:
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 cmH(2)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.
Filiaciones:
Pham, T:
Unity Heath Toronto, Li Ka Shing Knowledge Inst, Keenan Res Ctr, St Michaels Hosp, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Univ Paris Saclay, Serv Med Intens Reanimat, Grp Rech Clin CARMAS, Hop Bicetre,AP HP,FHU SEPSIS,DMU CORREVE, Le Kremlin Bicetre, France
Univ Paris Saclay, Univ Paris Sud, CESP, Equipe Epidemiol Resp Integrat,UVSQ,Inserm, Villejuif, France
Pesenti, A:
Osped Maggiore Policlin, Fdn IRCCS Ca Granda, Dipartimento Anestesia Rianimaz Emergenza Urgenza, Milan, Italy
Univ Milan, Dipartimento Fisiopatol Med Chirurg & Trapianti, Milan, Italy
Bellani, G:
Univ Milano Bicocca, Sch Med & Surg, Monza, Italy
San Gerardo Hosp, Dept Emergency & Intens Care, Monza, Italy
Rubenfeld, G:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Sunnybrook Hlth Sci Ctr, Program Trauma Emergency & Crit Care, Toronto, ON, Canada
Fan, E:
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Univ Hlth Network, Dept Med, Toronto, ON, Canada
Mt Sinai Hosp, Toronto, ON, Canada
Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
Bugedo, G:
Pontificia Univ Catolica Chile, Fac Med, Dept Med Intens, Santiago, Chile
Lorente, JA:
Hosp Univ Getafe, Crit Care Dept, Madrid, Spain
CIBER Enfermedades Resp, Madrid, Spain
Univ Europea, Madrid, Spain
Fernandes, AD:
Hosp Garcia de Orta, Serv Med Intens, EPE, Almada, Portugal
Van Haren, F:
Canberra Hosp, Intens Care Unit, Garran, Australia
Australian Natl Univ, Canberra Hosp, Med Sch, Garran, Australia
Univ Canberra, Fac Hlth, Canberra, ACT, Australia
Bruhn, A:
Pontificia Univ Catolica Chile, Fac Med, Dept Med Intens, Santiago, Chile
Rios, F:
Hosp Nacl Alejandro Posadas, Intens Care Unit, Buenos Aires, DF, Argentina
Esteban, A:
Hosp Univ Getafe, Ctr Invest Red Enfermedades Resp CIBERES, Madrid, Spain
Gattinoni, L:
Univ Gottingen, Dept Anaesthesiol Emergency & Intens Care Med, Gottingen, Germany
Larsson, A:
Uppsala Univ, Dept Med Sci, Uppsala, Sweden
McAuley, DF:
Queens Univ Belfast, Ctr Expt Med, Belfast, Antrim, North Ireland
Royal Victoria Hosp, Reg Intens Care Unit, Belfast, Antrim, North Ireland
Ranieri, M:
Univ Bologna, Policlin St Orsola, Alma Mater Studiorum, Dipartimento Sci Med & Chirurg,Anesthesia & Inten, Bologna, Italy
Thompson, BT:
Harvard Sch Med, Massachusetts Gen Hosp, Dept Med, Div Pulm & Crit Care Med, Boston, MA USA
Wrigge, H:
Univ Hosp Leipzig, Dept Anesthesiol & Intens Care Med, Leipzig, Germany
Bergmannstrost Hosp Halle, Dept Anesthesiol Intens Care & Emergency Med, Pain Therapy, Halle, Germany
Brochard, LJ:
Unity Heath Toronto, Li Ka Shing Knowledge Inst, Keenan Res Ctr, St Michaels Hosp, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Laffey, JG:
Unity Heath Toronto, Li Ka Shing Knowledge Inst, Keenan Res Ctr, St Michaels Hosp, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
St Michaels Hosp, Dept Anesthesia, Toronto, ON, Canada
Univ Toronto, Toronto, ON, Canada
Natl Univ Ireland Galway, Sch Med, Galway, Ireland
Natl Univ Ireland Galway, Regenerat Med Inst IREMEDI, CURAM Ctr Res Med Devices, Galway, Ireland
Mancebo J.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Schomer, Ashley M.:
Brigham and Women's Hospital, Boston, United States
Green Submitted, Green Published
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