Evidence map›Paper›PMID 27757516›Full record

Observational studyIntensive care medicine2016

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

John G Laffey, Giacomo Bellani, Tài Pham, Eddy Fan, Fabiana Madotto, Ednan K Bajwa, Laurent Brochard, Kevin Clarkson, Andres Esteban, Luciano Gattinoni and 16 more

Erratum issued 5 registry-linked trialsAbstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to 5 registered trials, which are not on this map. Cited by 180 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
180citing papers in PubMed, 8 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02010073 completednot on this map

A Multicentre, Prospective, Observational, 4-week Inception Cohort Study Being Carried Out by the Acute Respiratory Failure Section of ESICM

TypeobservationalSponsorEuropean Society of Intensive Care MedicineRan2014 to 2014Enrolled14,000ConditionsAcute Severe Respiratory Failure, Acute Respiratory Distress Syndrome
NCT03415529 completednot on this mapstarted 2018, after this paper: background citation

Incidence of Hypercapnia and Impact of Arterial CO2 Tension on Management and Outcome in Patients With Acute Respiratory Distress Syndrome (ARDS)

TypeobservationalSponsorEuropean Society of Intensive Care MedicineRan2018 to 2018Enrolled4,500ConditionsAcute Severe Respiratory Failure, Acute Respiratory Distress Syndrome
NCT03719937 nasuspendednot on this mapstarted 2018, after this paper: background citation

ArtificiaL Increase in chesT Wall Elastance as an alteRnative to PRONE Positioning in Moderate-to-severe ARDS: a Physiological Study The ALTERPRONE Study

TypeinterventionalSponsorCatholic University of the Sacred HeartRan2018 to 2023Enrolled15ConditionsAcute Respiratory Distress SyndromeArmsweight on the anterior chest of the patient
NCT04419376 completednot on this mapstarted 2018, after this paper: background citation

Driving Pressure and Mortality: in the Pediatric Intensive Care Unit (PICU)

Typeobservational_patient_registrySponsorDr. Behcet Uz Children's HospitalRan2018 to 2020Enrolled116ConditionsARDS, Human, Respiratory FailureArmsdriving pressure
NCT06288724 unknown statusnot on this mapstarted 2024, after this paper: background citation

Potentially MOdifiable Factors To ImproVe Outcomes of Mechanically Ventilated Patients in ICUs in a Low-income Country: Rationale and Protocol for a Registry-embedded Prospective Observational Study

Typeobservational_patient_registrySponsorNat Intensive Care Surveillance - MORURan2024 to 2024Enrolled625ConditionsCritical Illness, Invasive Mechanical Ventilation, ICU Mortality, Developing Countries
3 · Its place in the literature

Who cites it

180 citing papers in PubMed, 8 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
    Guideline
  4. Predictive Value of the PaOInternal medicine (Tokyo, Japan) · 2025
    Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
    Guideline
  9. Trial
  10. Article
  11. Article
  12. Observational
  13. Article
  14. Review
  15. Article
  16. Article
  17. Review
  18. Review
  19. Observational
  20. Article

120 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

26 authors.

John G LaffeyDepartments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Canada. laffeyj@smh.ca.ORCID http://orcid.org/0000-0002-1246-9573
Giacomo BellaniSchool of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Tài PhamAP-HP, Hôpital Tenon, Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France.
Eddy FanDepartment of Medicine, University Health Network, Mount Sinai Hospital, Toronto, Canada.
Fabiana MadottoResearch Center on Public Health, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Ednan K BajwaDivision of Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Laurent BrochardKeenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
Kevin ClarksonDepartment of Anaesthesia, National University of Ireland, Galway University Hospitals, Galway, Ireland.
Andres EstebanHospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain.
Luciano GattinoniDepartment of Anesthesiology, Emergency and Intensive Care Medicine Universitätsmedizin Göttingen, Robert Koch Strasse 40, 37073, Göttingen, Germany.
Frank van HarenIntensive Care Unit, The Canberra Hospital, Australian National University, Canberra, Australia.
Leo M HeunksDepartment of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Kiyoyasu KurahashiDepartment of Anesthesiology, Yokohama City University Medical Center, Kanagawa, Japan.
Jon Henrik LaakeDivision of Critical Care, Department of Anaesthesiology, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway.
Anders LarssonSection of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Daniel F McAuleyCentre for Experimental Medicine, Queen's University of Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast and Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK.
Lia McNameeCentre for Experimental Medicine, Queen's University of Belfast, Wellcome-Wolfson Institute for Experimental Medicine, Belfast and Regional Intensive Care Unit, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland, UK.
Nicolas NinHospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain.
Haibo QiuDepartment of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
Marco RanieriSAPIENZA Università di ROMA, Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Gordon D RubenfeldInterdepartmental Division of Critical Care Medicine, University of Toronto and Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, Canada.
B Taylor ThompsonDivision of Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Hermann WriggeDepartment of Anesthesiology and Intensive Care Medicine, University of Leipzig, 04103, Leipzig, Germany.
Arthur S SlutskyKeenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
Antonio PesentiDipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Toronto, Canada.
LUNG SAFE Investigators and the ESICM Trials Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo improve the outcome of the acute respiratory distress syndrome (ARDS), one needs to identify potentially modifiable factors associated with mortality.

methodsThe large observational study to understand the global impact of severe acute respiratory failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across five continents. A pre-specified secondary aim was to examine the factors associated with outcome. Analyses were restricted to patients (93.1 %) fulfilling ARDS criteria on day 1-2 who received invasive mechanical ventilation.

results2377 patients were included in the analysis. Potentially modifiable factors associated with increased hospital mortality in multivariable analyses include lower PEEP, higher peak inspiratory, plateau, and driving pressures, and increased respiratory rate. The impact of tidal volume on outcome was unclear. Having fewer ICU beds was also associated with higher hospital mortality. Non-modifiable factors associated with worsened outcome from ARDS included older age, active neoplasm, hematologic neoplasm, and chronic liver failure. Severity of illness indices including lower pH, lower PaO

conclusionsHigher PEEP, lower peak, plateau, and driving pressures, and lower respiratory rate are associated with improved survival from ARDS.

trial registrationClinicalTrials.gov NCT02010073.

Indexed as

AdultAgedComorbidityFemaleHospital MortalityHumansIntensive Care UnitsMaleMiddle AgedProspective StudiesRespiration, ArtificialRespiratory Distress SyndromeRisk FactorsSeverity of Illness IndexTidal VolumeTreatment OutcomeAcute respiratory distress syndromeDriving pressurePatient outcomePeak inspiratory pressurePositive end-expiratory pressure

Identifiers

PMID27757516

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.