Outcomes of Patients Presenting with Mild Acute Respiratory Distress Syndrome: Insights from the LUNG SAFE Study.


BACKGROUND:Patients with initial mild acute respiratory distress syndrome are often underrecognized and mistakenly considered to have low disease severity and favorable outcomes. They represent a relatively poorly characterized population that was only classified as having acute respiratory distress syndrome in the most recent definition. Our primary objective was to describe the natural course and the factors associated with worsening and mortality in this population. METHODS:This study analyzed patients from the international prospective Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) who had initial mild acute respiratory distress syndrome in the first day of inclusion. This study defined three groups based on the evolution of severity in the first week: "worsening" if moderate or severe acute respiratory distress syndrome criteria were met, "persisting" if mild acute respiratory distress syndrome criteria were the most severe category, and "improving" if patients did not fulfill acute respiratory distress syndrome criteria any more from day 2. RESULTS:Among 580 patients with initial mild acute respiratory distress syndrome, 18% (103 of 580) continuously improved, 36% (210 of 580) had persisting mild acute respiratory distress syndrome, and 46% (267 of 580) worsened in the first week after acute respiratory distress syndrome onset. Global in-hospital mortality was 30% (172 of 576; specifically 10% [10 of 101], 30% [63 of 210], and 37% [99 of 265] for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively), and the median (interquartile range) duration of mechanical ventilation was 7 (4, 14) days (specifically 3 [2, 5], 7 [4, 14], and 11 [6, 18] days for patients with improving, persisting, and worsening acute respiratory distress syndrome, respectively). Admissions for trauma or pneumonia, higher nonpulmonary sequential organ failure assessment score, lower partial pressure of alveolar oxygen/fraction of inspired oxygen, and higher peak inspiratory pressure were independently associated with worsening. CONCLUSIONS:Most patients with initial mild acute respiratory distress syndrome continue to fulfill acute respiratory distress syndrome criteria in the first week, and nearly half worsen in severity. Their mortality is high, particularly in patients with worsening acute respiratory distress syndrome, emphasizing the need for close attention to this patient population.






Pham T,Serpa Neto A,Pelosi P,Laffey JG,De Haro C,Lorente JA,Bellani G,Fan E,Brochard LJ,Pesenti A,Schultz MJ,Artigas A,LUNG SAFE Investigators* and the European Society of Intensive Care Medicine Trials Group.




Has Abstract


2019-02-01 00:00:00












  • Performance of noninvasive partial CO2 rebreathing cardiac output and continuous thermodilution cardiac output in patients undergoing aortic reconstruction surgery.

    abstract:BACKGROUND:In the partial CO(2) rebreathing method, monitored changes in CO(2) elimination and end-tidal CO(2) in response to a brief rebreathing period are used to estimate cardiac output. However, dynamic changes in CO(2) production during ischemia and reperfusion may affect the accuracy of these estimates. This stud...


    pub_type: 临床试验,杂志文章


    authors: Kotake Y,Moriyama K,Innami Y,Shimizu H,Ueda T,Morisaki H,Takeda J

    更新日期:2003-08-01 00:00:00

  • Bicitra (sodium citrate) and metoclopramide in outpatient anesthesia for prophylaxis against aspiration pneumonitis.

    abstract::To evaluate the effect of Bicitra (Willen Drug Company, Baltimore, Maryland), a commercial preparation of sodium citrate and metoclopramide, on gastric contents 150 elective outpatients allocated into six groups with 25 patients in each group were studied. Patients in Group 1 served as controls. Patients in Groups 2, ...


    pub_type: 杂志文章


    authors: Manchikanti L,Grow JB,Colliver JA,Hadley CH,Hohlbein LJ

    更新日期:1985-10-01 00:00:00

  • Identifying and Treating Opioid Side Effects: The Development of Methylnaltrexone.

    abstract::Methylnaltrexone Reverses Chronic Opioid-induced Constipation: A Randomized, Controlled Trial. By Yuan CS, Foss JF, O'Connor M, Osinski J, Karrison T, Moss J, Roizen MF. JAMA 2000; 130:142-8. Reprinted with permission. CONTEXT:Constipation is the most common chronic adverse effect of opioid pain medications in patien...


    pub_type: 杂志文章,随机对照试验


    authors: Moss J

    更新日期:2019-01-01 00:00:00

  • Intrathecal adenosine: interactions with spinal clonidine and neostigmine in rat models of acute nociception and postoperative hypersensitivity.

    abstract:BACKGROUND:Spinal adenosine receptor agonists exert antinociception in animal models of acute and chronic pain, but adenosine itself has not been examined. The authors tested the antinociceptive and antihypersensitivity interactions of intrathecal adenosine and its interactions with intrathecal clonidine and neostigmin...


    pub_type: 杂志文章


    authors: Chiari AI,Eisenach JC

    更新日期:1999-05-01 00:00:00

  • "Gentlemen! This Is No Humbug": Did John Collins Warren, M.D., Proclaim These Words on October 16, 1846, at Massachusetts General Hospital, Boston?

    abstract::The proclamation, "Gentlemen! this is no humbug," attributed to John Collins Warren, M.D., was not identified in any contemporaneous eyewitness report of William T. G. Morton's October 16, 1846, demonstration of ether at Massachusetts General Hospital. The earliest known documentation of the proclamation is in Nathan ...


    pub_type: 传,历史文章,杂志文章


    authors: Haridas RP

    更新日期:2016-03-01 00:00:00

  • Nitrous oxide does not induce myocardial ischemia in patients with ischemic heart disease and poor ventricular function.

    abstract::Despite evidence from animal experiments to the contrary, nitrous oxide (N2O) reportedly does not induce myocardial ischemia when used as an adjunct to fentanyl anesthesia in patients with coronary artery disease who have well-preserved left ventricular (LV) function. However, the incidence of ischemia with N2O admini...


    pub_type: 杂志文章


    authors: Mitchell MM,Prakash O,Rulf EN,van Daele ME,Cahalan MK,Roelandt JR

    更新日期:1989-10-01 00:00:00

  • Effect of direct fetal opioid analgesia on fetal hormonal and hemodynamic stress response to intrauterine needling.

    abstract:BACKGROUND:Whether the fetus can experience pain remains controversial. During the last half of pregnancy, the neuroanatomic connections for nociception are in place, and the human fetus mounts sizable stress responses to physical insults. Analgesia has been recommended for intrauterine procedures or late termination, ...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Fisk NM,Gitau R,Teixeira JM,Giannakoulopoulos X,Cameron AD,Glover VA

    更新日期:2001-10-01 00:00:00

  • Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury.

    abstract:BACKGROUND:To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury. METHODS:The authors conducted a prospective observational study across 17 sites. TCD was performed upon admission in 356 patients (Glasgow Coma Score [GCS], 9 to 15) with...


    pub_type: 杂志文章,多中心研究


    authors: Bouzat P,Almeras L,Manhes P,Sanders L,Levrat A,David JS,Cinotti R,Chabanne R,Gloaguen A,Bobbia X,Thoret S,Oujamaa L,Bosson JL,Payen JF,Asehnoune K,Pes P,Lefrant JY,Mirek S,Albasini F,Scrimgeour C,Thouret JM,Char

    更新日期:2016-08-01 00:00:00

  • Influence of administration rate on propofol plasma-effect site equilibration.

    abstract:BACKGROUND:The authors hypothesized a difference in plasma-effect site equilibration, depicted by a first-order constant k(e0), depending on the injection rate of propofol. METHODS:Sixty-one patients received 2.5 mg/kg propofol given as a bolus or as a 1-, 2-, or 3-min infusion. The Bispectral Index was used to monito...


    pub_type: 杂志文章,随机对照试验


    authors: Struys MM,Coppens MJ,De Neve N,Mortier EP,Doufas AG,Van Bocxlaer JF,Shafer SL

    更新日期:2007-09-01 00:00:00

  • Sepsis is associated with a preferential diaphragmatic atrophy: a critically ill patient study using tridimensional computed tomography.

    abstract:BACKGROUND:Diaphragm and psoas are affected during sepsis in animal models. Whether diaphragm or limb muscle is preferentially affected during sepsis in the critically ill remains unclear. METHODS:Retrospective secondary analysis study including 40 patients, comparing control (n = 17) and critically ill patients, with...


    pub_type: 杂志文章


    authors: Jung B,Nougaret S,Conseil M,Coisel Y,Futier E,Chanques G,Molinari N,Lacampagne A,Matecki S,Jaber S

    更新日期:2014-05-01 00:00:00

  • Comparison of bispectral index and composite auditory evoked potential index for monitoring depth of hypnosis in children.

    abstract:BACKGROUND:In pediatric patients, the Bispectral Index (BIS), derived from the electroencephalogram, and the composite A-Line autoregressive index (cAAI), derived from auditory evoked potentials and the electroencephalogram, have been used as measurements of depth of hypnosis during anesthesia. The performance and reli...


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    authors: Blussé van Oud-Alblas HJ,Peters JW,de Leeuw TG,Tibboel D,Klein J,Weber F

    更新日期:2008-05-01 00:00:00

  • A comparison of the effects of halothane and tetrodotoxin on the regional repolarization characteristics of canine Purkinje fibers.

    abstract::The effects of halothane, tetrodotoxin (TTX), veratridine (VTD), and alterations of extracellular calcium ion concentration [Ca++]0) on regional differences of canine Purkinje fiber action potential duration (APD50 and APD90) were investigated in vitro at a paced rate of 75 beats per min. Under control conditions (n =...


    pub_type: 杂志文章


    authors: Turner LA,Marijic J,Kampine JP,Bosnjak ZJ

    更新日期:1990-12-01 00:00:00

  • Isoflurane activates intestinal sphingosine kinase to protect against renal ischemia-reperfusion-induced liver and intestine injury.

    abstract:BACKGROUND:Renal ischemia-reperfusion injury (IRI) is a major cause of acute kidney injury and often leads to multiorgan dysfunction and systemic inflammation. Volatile anesthetics have potent antiinflammatory effects. We aimed to determine whether the representative volatile anesthetic isoflurane protects against acut...


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    authors: Kim M,Park SW,Kim M,D'Agati VD,Lee HT

    更新日期:2011-02-01 00:00:00

  • Propofol: the challenges of formulation.

    abstract::Propofol is a potent lipophilic anesthetic that was initially formulated in Cremophor El for human use. Because of the occurrence of Cremophor EL anaphylaxis and improvements in the quality of lipid emulsions, it was ultimately brought to market as 1% propofol formulated in 10% soybean oil emulsion. Emulsions represen...


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    authors: Baker MT,Naguib M

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  • Automated echocardiographic analysis. Examination of serial intraoperative measurements.

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    pub_type: 杂志文章


    authors: Perrino AC Jr,Luther MA,O'Connor TZ,Cohen IS

    更新日期:1995-08-01 00:00:00

  • Isoflurane provides long-term protection against focal cerebral ischemia in the rat.

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    authors: Sakai H,Sheng H,Yates RB,Ishida K,Pearlstein RD,Warner DS

    更新日期:2007-01-01 00:00:00

  • Muscular Tissue Oxygen Saturation and Posthysterectomy Nausea and Vomiting.

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    authors: Li G,Tian DD,Wang X,Feng X,Zhang W,Bao J,Wang DX,Ai YQ,Liu Y,Zhang M,Xu M,Mu DL,Zhao X,Dai F,Yang JJ,Che X,Yanez D,Guo X,Meng L,iMODIPONV Research Group.

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  • A comparative evaluation of the effects of multiple vasodilators on human internal mammary artery.

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    pub_type: 杂志文章


    authors: Huraux C,Makita T,Montes F,Szlam F,Levy JH

    更新日期:1998-06-01 00:00:00

  • Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery.

    abstract:BACKGROUND:Given the current practice environment, it is important to determine the anesthetic technique with the highest patient acceptance and lowest associated costs. The authors compared three commonly used anesthetic techniques for anorectal procedures in the ambulatory setting. METHODS:Ninety-three consenting ad...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Li S,Coloma M,White PF,Watcha MF,Chiu JW,Li H,Huber PJ Jr

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  • Volatile organic compounds during inflammation and sepsis in rats: a potential breath test using ion-mobility spectrometry.

    abstract:BACKGROUND:Multicapillary column ion-mobility spectrometry (MCC-IMS) may identify volatile components in exhaled gas. The authors therefore used MCC-IMS to evaluate exhaled gas in a rat model of sepsis, inflammation, and hemorrhagic shock. METHODS:Male Sprague-Dawley rats were anesthetized and ventilated via tracheost...


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    authors: Fink T,Wolf A,Maurer F,Albrecht FW,Heim N,Wolf B,Hauschild AC,Bödeker B,Baumbach JI,Volk T,Sessler DI,Kreuer S

    更新日期:2015-01-01 00:00:00

  • Ultrasound-guided internal jugular venous cannulation in infants: a prospective comparison with the traditional palpation method.

    abstract:BACKGROUND:Percutaneous cannulation of the internal jugular vein in infants is technically more difficult and carries a higher risk of carotid artery puncture than in older children and adults. In this prospective study, the authors tested their hypothesis that using an ultrasound scanner would increase the success of ...


    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Verghese ST,McGill WA,Patel RI,Sell JE,Midgley FM,Ruttimann UE

    更新日期:1999-07-01 00:00:00

  • In vivo fluorescence-mediated tomography imaging demonstrates atorvastatin-mediated reduction of lesion macrophages in ApoE-/- mice.

    abstract:BACKGROUND:Macrophage recruitment into atherosclerotic plaques drives lesion progression, destabilization, and rupture. Chronic statin treatment reduces macrophage plaque content. Information on dynamics of macrophage recruitment would help assessing plaque vulnerability and guiding therapy. Techniques to image macroph...


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    authors: Larmann J,Frenzel T,Schmitz M,Hahnenkamp A,Demmer P,Immenschuh S,Tietge UJ,Bremer C,Theilmeier G

    更新日期:2013-07-01 00:00:00

  • Time-dependent inhibition of G protein-coupled receptor signaling by local anesthetics.

    abstract:BACKGROUND:Several beneficial effects of local anesthetics (LAs) were shown to be due to inhibition of G protein-coupled receptor signaling. Differences in exposure time might explain discrepancies in concentrations of LAs required to achieve these protective effects in vivo and in vitro (approximately 100-fold higher)...


    pub_type: 杂志文章


    authors: Hollmann MW,Herroeder S,Kurz KS,Hoenemann CW,Struemper D,Hahnenkamp K,Durieux ME

    更新日期:2004-04-01 00:00:00

  • Cerebral and systemic effects of hypotension induced by adenosine or ATP in dogs.

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    pub_type: 杂志文章


    authors: Newberg LA,Milde JH,Michenfelder JD

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  • Thiopental alters contraction, intracellular Ca2+, and pH in rat ventricular myocytes.

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    pub_type: 杂志文章


    authors: Kanaya N,Zakhary DR,Murray PA,Damron DS

    更新日期:1998-07-01 00:00:00

  • Deficit Accumulation and Phenotype Assessments of Frailty Both Poorly Predict Duration of Hospitalization and Serious Complications after Noncardiac Surgery.

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    pub_type: 杂志文章


    authors: Sonny A,Kurz A,Skolaris LA,Boehm L,Reynolds A,Cummings KC 3rd,Makarova N,Yang D,Sessler DI

    更新日期:2020-01-01 00:00:00

  • Morbidity and mortality from anesthesia: a continuing problem.

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    pub_type: 杂志文章


    authors: Epstein RM

    更新日期:1978-12-01 00:00:00

  • Influence of erythrocyte concentrate storage time on postsurgical morbidity in cardiac surgery patients.

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    pub_type: 临床试验,杂志文章


    authors: Leal-Noval SR,Jara-López I,García-Garmendia JL,Marín-Niebla A,Herruzo-Avilés A,Camacho-Laraña P,Loscertales J

    更新日期:2003-04-01 00:00:00

  • Response to mivacurium in a patient compound heterozygous for a novel and a known silent mutation in the butyrylcholinesterase gene: genotyping by sequencing.

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    pub_type: 杂志文章


    authors: Gätke MR,Ostergaard D,Bundgaard JR,Varin F,Viby-Mogensen J

    更新日期:2001-09-01 00:00:00

  • Influence of sevoflurane on the metabolism and renal effects of compound A in rats.

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    pub_type: 杂志文章


    authors: Kharasch ED,Schroeder JL,Sheffels P,Liggitt HD

    更新日期:2005-12-01 00:00:00