Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome: insights from the LUNG SAFE study

Contains fulltext : 218568.pdf (publisher's version ) (Open Access)BACKGROUND: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this 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 LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 >/= 0.60 during hyperoxemia). RESULTS: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). CONCLUSIONS: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. TRIAL REGISTRATION: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

[Translated article] Clinical–Epidemiological Profile, and Treatment Response in Relation to Associated Atopic Comorbidity in Atopic Dermatitis. Experience From the BIOBADATOP Registry

Background: Despite advances made in treatments for atopic dermatitis (AD), information on its impact and interaction with atopic comorbidities, such as asthma, rhinoconjunctivitis, and ocular disease is limited. This study aims to assess the clinical–epidemiological characteristics of patients with AD – treatment response included – while taking into consideration atopic comorbidities like these. Materials and methods: Data were analyzed from the multicenter BIOBADATOP registry (a prospective cohort of AD patients initiating systemic treatment). We conducted a descriptive analysis of the main characteristics collected in the registry in relation to atopic comorbidity. Results: We included a total of 509 patients, mostly adults (81.9%) with severe AD (73.7%). Patients with personal atopic comorbidity (64%) more frequently exhibited flexural dermatitis (89.7% vs. 81.5%), a higher mean of previous systemic treatments (1.6 vs. 1.3), and higher baseline values on the POEM scale (19.6 vs. 17.9). Patients with familial atopic comorbidity (40.7%) had a higher incidence of pediatric/adolescent patients (24.2% vs. 13.9%) and a history of allergic rhinoconjunctivitis (61.1% vs. 47.1%). No differences regarding treatment response were observed at the 6- and 12-month follow-ups based on the presence or absence of atopic comorbidities. Conclusions: Results suggest that a history of atopic comorbidity is associated with an early onset and persistent course of AD. Although no differences were reported in the short-term treatment response, further follow-up is required to better understand the impact of comorbidities on AD. Resumen: Antecedentes: Pese al avance terapéutico en la dermatitis atópica (DA), la información sobre el impacto y la interacción con las comorbilidades atópicas (como el asma, la rinoconjuntivitis y la afección ocular) es limitada. Este estudio pretende evaluar las características clínicas y epidemiológicas de los pacientes con DA, así como la respuesta al tratamiento, considerando dichas comorbilidades. Material y métodos: Se realizó un análisis descriptivo de los datos del registro multicéntrico BIOBADATOP, una cohorte prospectiva de los pacientes con DA, que inician tratamiento sistémico, según la comorbilidad atópica. Resultados: Se incluyeron 509 pacientes, siendo mayoritariamente adultos (81,9%), con DA grave (73,7%). Los pacientes con comorbilidad atópica personal (64%) presentaron con mayor frecuencia dermatitis flexural (89,7 vs. 81,5%), mayor media de tratamientos sistémicos utilizados (1,6 vs. 1,3) y valores basales mayores en la escala POEM (19,6 vs. 17,9). Entre los pacientes con comorbilidad atópica familiar (40,7%) hubo mayor número de pacientes pediátricos/adolescentes (24,2 vs. 13,9%) y con antecedente de rinoconjuntivitis alérgica (61,1 vs. 47,1%). No se observaron diferencias en la respuesta a los tratamientos a los 6 y 12 meses, en función de la presencia o ausencia de comorbilidades atópicas. Conclusiones: Los resultados sugieren que el antecedente de comorbilidad atópica se asocia con inicio temprano y curso persistente de la DA. Aunque no se observaron diferencias en la evolución a corto plazo, se destaca la necesidad de mayor seguimiento para comprender mejor el impacto de las comorbilidades en la DA

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Perfil clínico, epidemiológico y respuesta al tratamiento, en función de la comorbilidad atópica asociada en la dermatitis atópica. Experiencia del registro BIOBADATOP

Resumen: Antecedentes: Pese al avance terapéutico en la dermatitis atópica (DA), la información sobre el impacto y la interacción con las comorbilidades atópicas (como el asma, la rinoconjuntivitis y la patología ocular) es limitada. Este estudio pretende evaluar las características clínicas y epidemiológicas de pacientes con DA, así como la respuesta al tratamiento, considerando dichas comorbilidades. Material y métodos: Se realizó un análisis descriptivo de los datos del registro multicéntrico BIOBADATOP, una cohorte prospectiva de pacientes con DA que inician tratamiento sistémico, según la comorbilidad atópica. Resultados: Se incluyeron 509 pacientes, siendo mayoritariamente adultos (81,9%), con DA grave (73,7%). Los pacientes con comorbilidad atópica personal (64%) presentaron con mayor frecuencia dermatitis flexural (89,7% vs. 81,5%), mayor media de tratamientos sistémicos utilizados (1,6 vs. 1,3) y valores basales mayores en la escala POEM (19,6 vs. 17,9). Entre los pacientes con comorbilidad atópica familiar (40,7%) hubo mayor número de pacientes pediátricos/adolescentes (24,2% vs. 13,9%) y con antecedente de rinoconjuntivitis alérgica (61,1% vs. 47,1%). No se observaron diferencias en la respuesta a los tratamientos a los 6 y 12 meses, en función de la presencia o ausencia de comorbilidades atópicas. Conclusiones: Los resultados sugieren que el antecedente de comorbilidad atópica se asocia con inicio temprano y curso persistente de la DA. Aunque no se observaron diferencias en la evolución a corto plazo, se destaca la necesidad de mayor seguimiento para comprender mejor el impacto de las comorbilidades en la DA. Abstract: Background: Despite advances made in treatments for atopic dermatitis (AD), information on its impact and interaction with atopic comorbidities, such as asthma, rhinoconjunctivitis, and ocular disease is limited. This study aims to assess the clinical-epidemiological characteristics of patients with AD—treatment response included—while taking into consideration atopic comorbidities like these. Materials and methods: Data were analyzed from the multicenter BIOBADATOP registry (a prospective cohort of AD patients initiating systemic treatment). We conducted a descriptive analysis of the main characteristics collected in the registry in relation to atopic comorbidity. Results: We included a total of 509 patients, mostly adults (81.9%) with severe AD (73.7%). Patients with personal atopic comorbidity (64%) more frequently exhibited flexural dermatitis (89.7% vs 81.5%), a higher mean of previous systemic treatments (1.6 vs. 1.3), and higher baseline values on the POEM scale (19.6 vs. 17.9). Patients with familial atopic comorbidity (40.7%) had a higher incidence of pediatric/adolescent patients (24.2% vs. 13.9%) and a history of allergic rhinoconjunctivitis (61.1% vs. 47.1%). No differences regarding treatment response were observed at the 6- and 12-month follow-ups based on the presence or absence of atopic comorbidities. Conclusions: Results suggest that a history of atopic comorbidity is associated with an early onset and persistent course of AD. Although no differences were reported in the short-term treatment response, further follow-up is required to better understand the impact of comorbidities on AD