Patterns of Use of Adjunctive Therapies in Patients With Early Moderate to Severe ARDS: Insights From the LUNG SAFE Study

the LUNG SAFE Investigators and the ESICM Trials Group

doi:10.1016/j.chest.2020.01.041

Patterns of Use of Adjunctive Therapies in Patients With Early Moderate to Severe ARDS: Insights From the LUNG SAFE Study

the LUNG SAFE Investigators and the ESICM Trials Group

Anaesthesia

Case Western Reserve University
University of Galway
University of Milano-Bicocca
Keenan Research Centre for Biomedical Science
Galway University Hospital
Assistance Publique-HÔpitaux de Paris, Université Paris Sud
Mt Sinai Hospital
Fondazione IRCCS San Gerardo dei Tintori
Sunnybrook Health Sciences Centre
University of Milan
Case Western Reserve University
University of Toronto
Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Research Centre for Medical Devices
Biomedical Sciences Building working group(Internal)
National University of Ireland, Galway
Nephrology Services
Galway University Hospitals
University of Toronto and Program in Trauma
Dipartimento di Anestesia
Department of Anaesthesia and Intensive Care Medicine

Research output: Contribution to a Journal (Peer & Non Peer) › Article › peer-review

50 Citations (Scopus)

Abstract

Background: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. Research Question: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (PaO₂/FIO₂ [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Study Design and Methods: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). Results: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. Interpretation: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. Trial Registry: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov

Original language	English
Pages (from-to)	1497-1505
Number of pages	9
Journal	Chest
Volume	157
Issue number	6
DOIs	https://doi.org/10.1016/j.chest.2020.01.041
Publication status	Published - Jun 2020

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

extracorporeal membrane oxygenation
high-frequency oscillation ventilation
neuromuscular blockade
nitric oxide
prone positioning
Aged
Extracorporeal Membrane Oxygenation/methods
Female
Humans
Male
Middle Aged
Neuromuscular Blockade/methods
Positive-Pressure Respiration/methods
Prospective Studies
Respiratory Distress Syndrome/diagnosis
Severity of Illness Index
Treatment Outcome

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10.1016/j.chest.2020.01.041

Cite this

@article{38d20184a6ad458ba9a20e60010f179f,

title = "Patterns of Use of Adjunctive Therapies in Patients With Early Moderate to Severe ARDS: Insights From the LUNG SAFE Study",

abstract = "Background: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. Research Question: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (PaO2/FIO2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Study Design and Methods: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). Results: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71\%) received no adjunct within 48 h of ARDS onset. Of 335 (29\%) that received adjunctive strategies, 252 (75\%) received a single strategy, and 83 (25\%) receiving more than one adjunct. Of ARDS nonsurvivors, 67\% did not receive any adjunctive strategy in the first 48 h. Most patients (67\%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. Interpretation: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. Trial Registry: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov",

keywords = "extracorporeal membrane oxygenation, high-frequency oscillation ventilation, neuromuscular blockade, nitric oxide, prone positioning, Aged, Extracorporeal Membrane Oxygenation/methods, Female, Humans, Male, Middle Aged, Neuromuscular Blockade/methods, Positive-Pressure Respiration/methods, Prospective Studies, Respiratory Distress Syndrome/diagnosis, Severity of Illness Index, Treatment Outcome",

author = "\{the LUNG SAFE Investigators and the ESICM Trials Group\} and Abhijit Duggal and Emanuele Rezoagli and T{\`a}i Pham and McNicholas, \{Bairbre A.\} and Eddy Fan and Giacomo Bellani and Gordon Rubenfeld and Pesenti, \{Antonio M.\} and Laffey, \{John G.\}",

note = "Publisher Copyright: {\textcopyright} 2020 American College of Chest Physicians",

year = "2020",

month = jun,

doi = "10.1016/j.chest.2020.01.041",

language = "English",

volume = "157",

pages = "1497--1505",

journal = "Chest",

issn = "0012-3692",

publisher = "Elsevier Inc.",

number = "6",

}

TY - JOUR

T1 - Patterns of Use of Adjunctive Therapies in Patients With Early Moderate to Severe ARDS

T2 - Insights From the LUNG SAFE Study

AU - the LUNG SAFE Investigators and the ESICM Trials Group

AU - Duggal, Abhijit

AU - Rezoagli, Emanuele

AU - Pham, Tài

AU - McNicholas, Bairbre A.

AU - Fan, Eddy

AU - Bellani, Giacomo

AU - Rubenfeld, Gordon

AU - Pesenti, Antonio M.

AU - Laffey, John G.

PY - 2020/6

Y1 - 2020/6

N2 - Background: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. Research Question: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (PaO2/FIO2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Study Design and Methods: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). Results: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. Interpretation: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. Trial Registry: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov

AB - Background: Adjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. Research Question: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (PaO2/FIO2 [P/F ratio] < 150) enrolled into the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Study Design and Methods: The LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150). Results: Of 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts. Interpretation: Three in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. Trial Registry: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov

KW - extracorporeal membrane oxygenation

KW - high-frequency oscillation ventilation

KW - neuromuscular blockade

KW - nitric oxide

KW - prone positioning

KW - Aged

KW - Extracorporeal Membrane Oxygenation/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neuromuscular Blockade/methods

KW - Positive-Pressure Respiration/methods

KW - Prospective Studies

KW - Respiratory Distress Syndrome/diagnosis

KW - Severity of Illness Index

KW - Treatment Outcome

UR - https://www.scopus.com/pages/publications/85084841642

U2 - 10.1016/j.chest.2020.01.041

DO - 10.1016/j.chest.2020.01.041

M3 - Article

C2 - 32088180

SN - 0012-3692

VL - 157

SP - 1497

EP - 1505

JO - Chest

JF - Chest

IS - 6

ER -

Patterns of Use of Adjunctive Therapies in Patients With Early Moderate to Severe ARDS: Insights From the LUNG SAFE Study

Abstract

UN SDGs

Keywords

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