Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study

Laffey, John G.; Bellani, Giacomo; Pham, Tài; Fan, Eddy; Madotto, Fabiana; Bajwa, Ednan K.; Brochard, Laurent; Clarkson, Kevin; Esteban, Andrés; Gattinoni, Luciano; Haren, Frank van; Heunks, Leo; Kurahashi, Kiyoyasu; Laake, Jon Henrik; Larsson, Anders; McAuley, Daniel F.; McNamee, Lia; Nin, Nicolás; Qiu, Haibo; Ranieri, Marco; Rubenfeld, Gordon D.; Thompson, B. Taylor; Wrigge, Hermann; Slutsky, Arthur S.; Pesenti, Antonio

doi:10.1007/s00134-016-4571-5

Cited by 279 publications

(255 citation statements)

References 31 publications

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“…There is a high variability in reported mortality of ARDS patients, probably reflecting differences in care, risk factors, ability to diagnose, and resource availability. However, in general, recent studies suggest a decrease in mortality rate from ARDS probably due to better ventilatory care and control of modifiable risk factors associated with mortality [15].…”

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confidence: 99%

Focus on ARDS

2017

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Since 1967, when first described, ARDS has been widely recognized as a major health problem worldwide, carrying a high morbidity and mortality [1][2][3]. This focus editorial summarizes recent advances about the incidence, pathophysiology, right ventricular dysfunction, and mortality of ARDS.Despite the attempt to homogenize its definition following the publication of the Berlin criteria, there is still a high heterogeneity in the epidemiology of ARDS across the world [3]. Indeed, estimates of the incidence of ARDS are highly variable, ranging from less than 2 to more than 70 cases per 100,000 person-years, with the most recent study on the topic suggesting a higher incidence in Europe, North America, and Oceania compared to South America, Asia, and Africa [2,3]. However, it is important to emphasize that this scenario could only reflect the under-recognition of this syndrome [3]. Recent reports suggest a progressive decline of the incidence of ARDS. In a study conducted in Rochester, cases fell by half between 2001 and 2008 while mortality remained stable [4]. Nearly all of the reduction in the incidence was observed in hospital-acquired ARDS, suggesting that ARDS could be prevented through strategies addressing its related risk factors [4,5]. However, in some instances, patients meeting the Berlin criteria for ARDS lack exposure to common risk factors [6]. It was recently reported that the prevalence of patients with ARDS but without common risk factors was as high as 7.5% [6]. According to medical history, bronchoalveolar lavage fluid cytology, and chest computed tomography (CT) scan patterns, four etiological categories were identified in this group of patients: immune, drug-induced, malignant, and idiopathic [6]. The overall ICU mortality rate was higher in patients lacking common risk factors as compared to their counterparts, even after adjustment for potential confounding factors [6].It is already well known that ventilator-induced lung injury contributes to ARDS-associated mortality [2,3]. Recently, some biological markers have been proposed as potential biomarkers of ARDS, such as the soluble form of the receptor for advanced glycation end-products (sRAGE). This biomarker is a transmembrane receptor that can bind multiple ligands resulting in intracellular signaling, leading to activation of the proinflammatory transcription factor nuclear factor κB [7]. Plasma levels of sRAGE could change according to ventilator settings in ARDS patients, as recently suggested by a study describing a significant decrease of sRAGE 1 h after a recruitment maneuver followed by an increase toward baseline values 4 h after the maneuver [7]. It has also been shown that sRAGE is higher in non-survivors than survivors in early pediatric ARDS and strongly correlated with number of non-pulmonary organ failures [8]. Other biomarkers of endothelial injury are also investigated in ARDS patients. Higher levels of circulating endothelial cells were found in the blood of patients with moderate-to-severe ARDS as compared to those with...

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confidence: 99%

Focus on ARDS

2017

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“…The association of ΔP with mortality in ARDS patients was confirmed in another large observational study [2]. Other studies also showed that high ΔP may detect lung overstress [3] and be associated with high morbidity [4].…”

Section: Introductionmentioning

confidence: 68%

Should We Care about Driving Pressure during Assisted Mechanical Ventilation?

Vaporidi¹,

Xirouchaki²,

Georgopoulos³

2017

J Intensive Crit Care

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“…All Tunisian and Moroccan ICUs that have taken part in such surveys are in university hospitals. In the area of respiratory medicine (organ system support and treatment), various departments of critical care medicine have joined European Society of Intensive Care Medicine trial groups (LUNG SAFE Investigators) and the VENTILA Group Consortium in the realization of international observational studies focusing on mechanical ventilation and acute respiratory distress syndrome (incidence, ventilation modalities, and outcome) [8,9].…”

Section: The Current State Of Researchmentioning

confidence: 99%