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. 2017 Jan 1;195(1):67-77.
doi: 10.1164/rccm.201606-1306OC.

Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study

Giacomo Bellani  1   2 , John G Laffey  3   4   5   6   7   8 , Tài Pham  9   10   11 , Fabiana Madotto  12 , Eddy Fan  8   13   14   15 , Laurent Brochard  4   8   14   15 , Andres Esteban  16 , Luciano Gattinoni  17 , Vesna Bumbasirevic  18   19 , Lise Piquilloud  20   21 , Frank van Haren  22   23 , Anders Larsson  24 , Daniel F McAuley  25   26 , Philippe R Bauer  27 , Yaseen M Arabi  28   29 , Marco Ranieri  30 , Massimo Antonelli  31 , Gordon D Rubenfeld  8   14   32 , B Taylor Thompson  33 , Hermann Wrigge  34 , Arthur S Slutsky  5   8   14 , Antonio Pesenti  35   36 ; LUNG SAFE Investigators; ESICM Trials Group
Collaborators, Affiliations
Free article

Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study

Giacomo Bellani et al. Am J Respir Crit Care Med. .
Free article

Abstract

Rationale: Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory distress syndrome (ARDS). The evidence supporting NIV use in patients with ARDS remains relatively sparse.

Objectives: To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2 Berlin criteria is useful.

Methods: The LUNG SAFE (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure) study described the management of patients with ARDS. This substudy 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.

Measurements and main 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 (hazard ratio, 1.446 [95% confidence interval, 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 mm Hg.

Conclusions: NIV was used in 15% of patients with ARDS, irrespective of severity category. NIV seems to be associated with higher ICU mortality in patients with a PaO2/FiO2 lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).

Keywords: acute respiratory distress syndrome; noninvasive ventilation.

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