TY - JOUR
TI - Rapidly Improving ARDS in Therapeutic Randomized Controlled Trials
AU - Schenck, Edward J.
AU - Oromendia, Clara
AU - Torres, Lisa K.
AU - Berlin,
AU - David A.
AU - Choi, Augustine M. K.
AU - Siempos, Ilias I.
JO - Journal of Chest Surgery
PY - 2019
VL - 155
TODO - 3
SP - 474-482
PB - ELSEVIER SCIENCE BV
SN - null
TODO - 10.1016/j.chest.2018.09.031
TODO - acute lung injury; acute respiratory failure; epidemiology; ICUs
TODO - BACKGROUND: Observational studies suggest that some patients meeting
criteria for ARDS no longer fulfill the oxygenation criterion early in
the course of their illness. This subphenotype of rapidly improving ARDS
has not been well characterized. We attempted to assess the prevalence,
characteristics, and outcomes of rapidly improving ARDS and to identify
which variables are useful to predict it.
METHOD: A secondary analysis was performed of patient level data from
six ARDS Network randomized controlled trials. We defined rapidly
improving ARDS, contrasted with ARDS > 1 day, as extubation or a PaO2 to
FiO(2) ratio (PaO2:FiO(2)) > 300 on the first study day following
enrollment.
RESULTS: The prevalence of rapidly improving ARDS was 10.5% (458 of
4,361 patients) and increased over time. Of the 1,909 patients enrolled
in the three most recently published trials, 197 (10.3%) were extubated
on the first study day, and 265 (13.9%) in total had rapidly improving
ARDS. Patients with rapidly improving ARDS had lower baseline severity
of illness and lower 60-day mortality (10.2% vs 26.3%; P < .0001) than
ARDS > 1 day. PaO2:FiO(2) at screening, change in PaO2:FiO(2) from
screening to enrollment, use of vasopressor agents, FiO(2) at
enrollment, and serum bilirubin levels were useful predictive variables.
CONCLUSIONS: Rapidly improving ARDS, mostly defined by early extubation,
is an increasingly prevalent and distinct subphenotype, associated with
better outcomes than ARDS > 1 day. Enrollment of patients with rapidly
improving ARDS may negatively affect the prognostic enrichment and
contribute to the failure of therapeutic trials.
ER -