title: Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study.
abstract: 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.
  
  
  
  To determine whether, during NIV, the categorization of ARDS severity based on the PaO2/FiO2Berlin criteria is useful.
  
  
  
  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/FiO2ratio in classifying patients receiving NIV, and the impact of NIV on outcome.
  
  
  
  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/FiO2ratio 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/FiO2lower than 150 mm Hg.
  
  
  
  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/FiO2lower than 150 mm Hg. Clinical trial registered with www.clinicaltrials.gov (NCT 02010073).
authors.affiliation: 1 Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.|2 Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bellani
authors.affiliation: 3 Department of Anesthesia.|4 Department of Critical Care Medicine, and.|5 Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.|6 Department of Anesthesia.|7 Department of Physiology.|8 Interdepartmental Division of Critical Care Medicine.
authors.forename: John G
authors.identifier: 0000-0002-1246-9573
authors.initials: JG
authors.lastname: Laffey
authors.affiliation: 9 Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies Aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France.|10 Unité Mixte de Recherche 1153, Inserm, Sorbonne Paris Cité, Epidémiologie Clinique et Statistiques, pour la Recherche en Santé Team, Université Paris Diderot, Paris, France.|11 Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, France.
authors.forename: Tài
authors.initials: T
authors.lastname: Pham
authors.affiliation: 12 Research Centre on Public Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Madotto
authors.affiliation: 8 Interdepartmental Division of Critical Care Medicine.|13 Institute of Health Policy, Management and Evaluation, and.|14 Department of Medicine, University of Toronto, Toronto, Canada.|15 Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
authors.forename: Eddy
authors.initials: E
authors.lastname: Fan
authors.affiliation: 4 Department of Critical Care Medicine, and.|8 Interdepartmental Division of Critical Care Medicine.|14 Department of Medicine, University of Toronto, Toronto, Canada.|15 Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, Canada.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.affiliation: 16 Hospital Universitario de Getafe, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain.
authors.forename: Andres
authors.initials: A
authors.lastname: Esteban
authors.affiliation: 17 Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Luciano
authors.initials: L
authors.lastname: Gattinoni
authors.affiliation: 18 School of Medicine, University of Belgrade, Belgrade, Serbia.|19 Department of Anesthesia and Intensive Care, Emergency Center, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Bumbasirevic
authors.affiliation: 20 Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland.|21 Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
authors.forename: Lise
authors.initials: L
authors.lastname: Piquilloud
authors.affiliation: 22 Intensive Care Unit, The Canberra Hospital, Canberra, Australia.|23 Australian National University, Canberra, Australia.
authors.forename: Frank
authors.initials: F
authors.lastname: van Haren
authors.affiliation: 24 Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
authors.affiliation: 25 Centre for Experimental Medicine, Queen's University of Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast, United Kingdom.|26 Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: McAuley
authors.affiliation: 27 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Bauer
authors.affiliation: 28 King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.|29 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
authors.affiliation: 30 Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Sapienza Università di Roma, Roma, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranieri
authors.affiliation: 31 Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore-Fondazione Policlinico Universitario A. Gemelli, Roma, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: 8 Interdepartmental Division of Critical Care Medicine.|14 Department of Medicine, University of Toronto, Toronto, Canada.|32 Sunnybrook Health Sciences Center, Toronto, Canada.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.affiliation: 33 Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.affiliation: 34 Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Wrigge
authors.affiliation: 5 Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.|8 Interdepartmental Division of Critical Care Medicine.|14 Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.affiliation: 35 Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione Istituto di ricovero e Cura a Carattere Scientifico Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy; and.|36 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pesenti
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods / Q000401:mortality; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: acute respiratory distress syndrome; noninvasive ventilation