Presence of comorbidities alters management and worsens outcome of patients with acute respiratory distress syndrome: insights from the LUNG SAFE study
| العنوان: | Presence of comorbidities alters management and worsens outcome of patients with acute respiratory distress syndrome: insights from the LUNG SAFE study |
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| المؤلفون: | Emanuele, Rezoagli, Bairbre A, McNicholas, Fabiana, Madotto, Tài, Pham, Giacomo, Bellani, John G, Laffey |
| المساهمون: | Rezoagli, E, Mcnicholas, B, Madotto, F, Pham, T, Bellani, G, Laffey, J, HAL UVSQ, Équipe, Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), National University of Ireland [Galway] (NUI Galway), IRCCS Multimedica, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Università degli Studi di Milano-Bicocca, European Society of Intensive Care Medicine, ESICM, This work was funded and supported by the European Society of Intensive Care Medicine (ESICM), Brussels, Belgium, by St Michael’s Hospital, Toronto, Canada, and by the University of Milan-Bicocca, Monza, Italy., LUNG SAFE Investigators, the ESICM Trials Group |
| المصدر: | Annals of Intensive Care Annals of Intensive Care, 2022, 12 (1), pp.42. ⟨10.1186/s13613-022-01015-7⟩ |
| بيانات النشر: | Springer, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | [SDV] Life Sciences [q-bio], Congestive heart failure, [SDV]Life Sciences [q-bio], Diabetes, Immune suppression, Chronic renal failure, Chronic liver failure, Chronic respiratory impairment, Comorbiditie, Critical Care and Intensive Care Medicine, Diabete, Comorbidities |
| الوصف: | Background The impact of underlying comorbidities on the clinical presentation, management and outcomes in patients with ARDS is poorly understood and deserves further investigation. Objectives We 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. Methods In 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. Results Of 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. Conclusions Most 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. |
| وصف الملف: | ELETTRONICO; application/pdf |
| اللغة: | English |
| تدمد: | 2110-5820 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::bc8b5e5be8f4bfa07b36451f5b8eec48 http://hdl.handle.net/10281/378758 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....bc8b5e5be8f4bfa07b36451f5b8eec48 |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 21105820 |
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