BACKGROUND: Non-invasive ventilation (NIV) is increasingly used in patients with Acute Respiratory Distress Syndrome (ARDS). Whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful is unknown. The evidence supporting NIV use in patients with ARDS remains relatively sparse. METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study described the management of patients with ARDS. This sub-study 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. RESULTS: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio 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 (HR 1.446; [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 mmHg. CONCLUSIONS: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV appears to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mmHg. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02010073

Bellani, G., Laffey, J., Pham, T., Madotto, F., Fan, E., Brochard, L., et al. (2016). Non-invasive Ventilation of Patients with ARDS: Insights from the LUNG SAFE Study. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE [10.1164/rccm.201606-1306OC].

Non-invasive Ventilation of Patients with ARDS: Insights from the LUNG SAFE Study

BELLANI, GIACOMO;MADOTTO, FABIANA;
2016

Abstract

BACKGROUND: Non-invasive ventilation (NIV) is increasingly used in patients with Acute Respiratory Distress Syndrome (ARDS). Whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful is unknown. The evidence supporting NIV use in patients with ARDS remains relatively sparse. METHODS: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study described the management of patients with ARDS. This sub-study 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. RESULTS: Of 2,813 patients with ARDS, 436 (15.5%) were managed with NIV on days 1 and 2 following fulfillment of diagnostic criteria. Classification of ARDS severity based on PaO2/FiO2 ratio 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 (HR 1.446; [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 mmHg. CONCLUSIONS: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV appears to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mmHg. Clinical trial registration available at www.clinicaltrials.gov, ID NCT02010073
Articolo in rivista - Articolo scientifico
Acute Respiratory Distress Syndrome; Non-invasive ventilation
English
Bellani, G., Laffey, J., Pham, T., Madotto, F., Fan, E., Brochard, L., et al. (2016). Non-invasive Ventilation of Patients with ARDS: Insights from the LUNG SAFE Study. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE [10.1164/rccm.201606-1306OC].
Bellani, G; Laffey, J; Pham, T; Madotto, F; Fan, E; Brochard, L; Esteban, A; Gattinoni, L; Bumbasirevic, V; Piquilloud, L; van Haren, F; Larsson, A; Mcauley, D; Bauer, P; Arabi, Y; Ranieri, M; Antonelli, M; Rubenfeld, G; Thompson, B; Wrigge, H; Slutsky, A; Pesenti, A
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/133793
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