ArticleAnnals of intensive care2022
Presence of comorbidities alters management and worsens outcome of patients with acute respiratory distress syndrome: insights from the LUNG SAFE study.
Article in Annals of intensive care, 2022. 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 18 papers.
What it found
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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
18 citing papers in PubMed, 33 citations in OpenAlex.
- 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
- Acute hYpErcapnic respiratory failure in The ICU: A multicenter prospective observational study - The YETI study.Annals of intensive care · 2026Article
- Organ Crosstalk During Injury: Mechanisms of Lung-Kidney Interaction in Critical Illness.Comprehensive Physiology · 2025Review
- Characteristics and temporality of the ventilatory techniques in the management of acute respiratory distress syndrome: A scoping review.Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures) · 2025Review
- Impact of comorbidities on management and outcomes of patients weaning from invasive mechanical ventilation: insights from the WEAN SAFE study.Critical care (London, England) · 2025Article
- Major psychiatric comorbidity among the critically ill: a multi-centred cohort study in Queensland.BMC psychiatry · 2025Article
- Observational
- Heterogeneous impact of Sighs on mortality in patients with acute hypoxemic respiratory failure: insights from the PROTECTION study.Annals of intensive care · 2024Article
- Elevated Hemoglobin A1c and the Risk of Developing ARDS in Two Cohort Studies.CHEST critical care · 2024Article
- Phenotyping COVID-19 respiratory failure in spontaneously breathing patients with AI on lung CT-scan.Critical care (London, England) · 2024Observational
- Algor-ethics: charting the ethical path for AI in critical care.Journal of clinical monitoring and computing · 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
- Translational medicine for acute lung injury.Journal of translational medicine · 2024Review
- Inhaled Nitric Oxide in Acute Respiratory Distress Syndrome Subsets: Rationale and Clinical Applications.Journal of aerosol medicine and pulmonary drug delivery · 2023Review
- Comorbidities, multimorbidity and COVID-19.Nature medicine · 2023Review
- Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies.Critical care (London, England) · 2023Article
- Inhaled nitric oxide: role in the pathophysiology of cardio-cerebrovascular and respiratory diseases.Intensive care medicine experimental · 2022Review
- The association of ESBLDrug target insightsArticle
Corrections and comments
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe impact of underlying comorbidities on the clinical presentation, management and outcomes in patients with ARDS is poorly understood and deserves further investigation.
objectivesWe examined these issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study.
methodsIn this secondary analysis of the patient cohort enrolled in the LUNG SAFE study, our primary objective was to determine the frequency, and impact of comorbidities on the management and ICU survival of patients with ARDS. Secondary outcomes relating to comorbidities included their impact on ventilatory management, the development of organ failures, and on end-of-life care.
resultsOf 2813 patients in the study population, 1692 (60%) had 1 or more comorbidities, of whom 631 (22.4%) had chronic respiratory impairment, 290 (10.3%) had congestive heart failure, 286 (10.2%) had chronic renal failure, 112 (4%) had chronic liver failure, 584 (20.8%) had immune incompetence, and 613 (21.8%) had diabetes. Multiple comorbidities were frequently present, with 423 (25%) having 2 and 182 (11%) having at least 3 or more comorbidities. The use of invasive ventilation (1379 versus 998, 82 versus 89%), neuromuscular blockade (301 versus 249, 18 versus 22%), prone positioning (97 versus 104, 6 versus 9%) and ECMO (32 versus 46, 2 versus 4%) were each significantly reduced in patients with comorbidities as compared to patients with no comorbidity (1692 versus 1121, 60 versus 40%). ICU mortality increased from 27% (n = 303) in patients with no comorbidity to 39% (n = 661) in patients with any comorbidity. Congestive heart failure, chronic liver failure and immune incompetence were each independently associated with increased ICU mortality. Chronic liver failure and immune incompetence were independently associated with more decisions to limitation of life supporting measures.
conclusionsMost patients with ARDS have significant comorbidities, they receive less aggressive care, and have worse outcomes. Enhancing the care of these patients must be a priority for future clinical studies. Trial registration LUNG-SAFE is registered with ClinicalTrials.gov, number NCT02010073.
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