ArticleChest2020
Patterns of Use of Adjunctive Therapies in Patients With Early Moderate to Severe ARDS: Insights From the LUNG SAFE Study.
Article in Chest, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02010073 (A Multicentre, Prospective, Observational, 4-week Inception Cohort Study Being Carried Out by the Acute Respiratory Failure Section of ESICM), which is not on this map. Cited by 36 papers, 1 of them a synthesis that pooled it.
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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.
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.
A Multicentre, Prospective, Observational, 4-week Inception Cohort Study Being Carried Out by the Acute Respiratory Failure Section of ESICM
Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 55 citations in OpenAlex.
- An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline.American journal of respiratory and critical care medicine · 2024Guideline
- Prone positioning in ARDS.Intensive care medicine · 2026Review
- Characterizing heterogeneity and subphenotyping acute respiratory distress syndrome with computed tomography.Intensive care medicine experimental · 2026Review
- Time-dependent effects in consecutive cycles of prone positioning for acute respiratory failure: insights from the PROVENT-C19 Registry.Journal of anesthesia, analgesia and critical care · 2026Article
- Review
- Prognostic value of disease severity and mechanical ventilation intensity in acute respiratory distress syndrome: analysis of the LUNG SAFE cohort.The European respiratory journal · 2026Observational
- Impact of proning with and without inhaled pulmonary vasodilators and neuromuscular blocking agents in COVID acute respiratory distress syndrome.World journal of critical care medicine · 2025Article
- Oxygenation improvement and duration of prone positioning are associated with ICU mortality in mechanically ventilated COVID-19 patients.Annals of intensive care · 2025Article
- Signs of Hemolysis Predict Mortality and Ventilator Associated Pneumonia in Severe Acute Respiratory Distress Syndrome Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation.ASAIO journal (American Society for Artificial Internal Organs : 1992) · 2025Article
- Impact of board-certified intensive care training facilities on choice of adjunctive therapies and prognosis of severe respiratory failure: a nationwide cohort study.Journal of intensive care · 2024Article
- Prone-position decreases airway closure in a patient with ARDS undergoing venovenous extracorporeal membrane oxygenation.Journal of clinical monitoring and computing · 2024Article
- Management of severe acute respiratory distress syndrome in Australia and New Zealand (SAGE-ANZ): An observational study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2024Article
- Perfusion deficits may underlie lung and kidney injury in severe COVID-19 disease: insights from a multicenter international cohort study.Journal of anesthesia, analgesia and critical care · 2024Review
- Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist.Intensive care medicine · 2024Review
- Unraveling the protective mechanisms of Chuanfangyihao against acute lung injury: Insights from experimental validation.Experimental and therapeutic medicine · 2023Article
- Prone Positioning in Acute Respiratory Distress Syndrome: Don't Stop Believing...Critical care medicine · 2023Article
- Clinical Applicability of Electrical Impedance Tomography in Patient-Tailored Ventilation: A Narrative Review.Tomography (Ann Arbor, Mich.) · 2023Review
- Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.BMJ health & care informatics · 2023Article
- Adaptation and Uncertainty: A Qualitative Examination of Provider Experiences With Prone Positioning for Intubated Patients With COVID-19 ARDS.CHEST critical care · 2023Article
- Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome Subsets: Rationale and Clinical Applications.Journal of aerosol medicine and pulmonary drug delivery · 2023Review
Corrections and comments
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Authors and funding
10 authors at 8 institutions in 5 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAdjunctive strategies are an important part of the management of ARDS. However, their application in clinical practice remains inconsistent. RESEARCH QUESTION: We wished to determine the frequency and patterns of use of adjunctive strategies in patients with moderate to severe ARDS (Pao STUDY DESIGN AND
methodsThe LUNG SAFE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted in 2014 in 459 ICUs from 50 countries. The primary objective of this substudy was to determine the frequency of use of widely available (neuromuscular blockade, prone position) adjuncts vs adjuncts requiring specialized equipment (extracorporeal membrane oxygenation, inhaled vasodilators, high-frequency ventilation) in patients in the first 48 h of moderate to severe ARDS (P/F ratio < 150).
resultsOf 1,146 patients on invasive ventilation with moderate to severe ARDS, 811 patients (71%) received no adjunct within 48 h of ARDS onset. Of 335 (29%) that received adjunctive strategies, 252 (75%) received a single strategy, and 83 (25%) receiving more than one adjunct. Of ARDS nonsurvivors, 67% did not receive any adjunctive strategy in the first 48 h. Most patients (67%) receiving specialized adjuncts did not receive prone positioning or neuromuscular blockade. Patients that received adjuncts were more likely to have their ARDS recognized, be younger and sicker, have pneumonia, be more difficult to ventilate, and be in a European high-income country than those that did not receive adjuncts.
interpretationThree in 10 patients with moderate to severe ARDS, and only one-third of nonsurvivors, received adjunctive strategies over the first 48 h of ARDS. A more consistent and evidence-driven approach to adjunct use may reduce costs and improve outcomes in patients with moderate to severe ARDS. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02010073; URL: www.clinicaltrials.gov.
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