July Better Ventilatory Management May Improve Outcomes in Females with Acute Respiratory Distress Syndrome

A new study by the LUNG SAFE Investigator group led by academics from NUI Galway, Galway University Hospitals, University of Toronto and University of Milan-Bicocco, have examined the differences in the management and outcomes of critically ill women and men who were diagnosed with Acute Respiratory Distress Syndrome (ARDS) and found that mortality rates were significantly higher in women diagnosed with severe confirmed ARDS and highlight the potential for better ventilatory management in females to improve their outcomes. 

Acute Respiratory Distress Syndrome (ARDS), is a form of acute lung injury that results from damage to the lung, in response to an injury such as pneumonia, sepsis or major trauma. When the breathing unit becomes inflamed it results in a reduced ability for gases including oxygen to be absorbed and carbon dioxide to be excreted. The condition occurs in a tenth of all patients admitted to the Intensive Care Unit, and nearly a quarter of all patients that require mechanical ventilation. There is no direct treatment for ARDS, and current management focuses on supporting lung function with artificial ventilation. ‘Protective’ lung ventilation approaches, which use patient height to guide the size of the breath delivered by the ventilator to the patient, help to reduce the risk of further lung damage, and improve survival in these patients.

Professor John Laffey, Professor of Anaesthesia and Intensive Care Medicine, NUI Galway and Galway University Hospitals and Professor Giacomo Bellani, University of Milan-Bicocco were the joint leads of the LUNG SAFE study, that included a group of over 1,000 researchers from 549 Intensive Care Units across 50 countries throughout the globe. The LUNG SAFE study gave the clearest picture of the incidence of ARDS globally. ARDS was seen in 10% of all patients admitted to Intensive Care Units and 20% of all patients requiring artificial ventilation.

The current study, published today (30 July 2019) in the European Respiratory Journal, examined differences in risk factors, management and outcomes between women and men who were admitted to an Intensive Care Unit with ARDS. The investigators reported important sex differences in the management and outcomes of patients with ARDS. Only half of females received protective lung ventilation, with shorter women more likely to receive non-protective ventilation compared even to men of similar height. Of particular concern, mortality rates were significantly higher in women with confirmed severe ARDS. Females with ARDS require particular care in order to optimise their ventilatory management and to improve their outcomes. These findings highlight the potential for better ventilatory management in females to improve their outcomes from ARDS.

Speaking about the study’s findings, Professor John Laffey from NUI Galway, said: “We found that shorter females with ARDS were at high risk to receive injurious lung ventilation, while mortality rates were significantly higher in women with confirmed severe ARDS. We concluded that better ventilatory management may improve outcomes in females with ARDS.”

Dr Bairbre McNicholas, Galway University Hospitals and joint first author of the study, stated: “The study brings to attention physiological differences between men and women in their response to acute lung injury - women could potentially fare better with ARDS if we are meticulous about how we manage their ventilation.”

This new study is a follow-up to the LUNG SAFE study in 2014, and is the largest observational study ever undertaken to understand the global impact of severe acute respiratory failure. The study found that ARDS has a higher incidence than previously thought, and is frequently underdiagnosed by physicians. Protective lung ventilatory strategies that reduce lung injury were not widely implemented across the world. The study looked at outcomes for countries based on how wealthy the country is based on their GDP as this would influence the availability of Intensive Care Unit resources. It found that despite differences in the wealth of countries, there was less differences in the incidence of ARDS than previously reported. Overall mortality for the condition is 40%, higher for patients with more severe versions of the disease.

This new LUNG SAFE study included a research group of scientists and intensivists (physicians who specialise in the care of critically ill patients in intensive care), was led by principal investigator Professor John Laffey, Professor of Anaesthesia and Intensive Care Medicine, NUI Galway and Galway University Hospitals, intensivist and joint co-author of the study, Dr Bairbre McNicholas, Intensive Care Unit, Galway University Hospitals, and Dr Claire Masterson and Dr Shahd Horie, researchers in Lung Biology at NUI Galway.

The new LUNG-SAFE study was sponsored by the European Society of Intensive Care Medicine (ESICM) trials group. 

To read the study in the European Respiratory Journal, visit: https://erj.ersjournals.com/content/early/2019/07/08/13993003.00609-2019 or for a full pdf version of the study contact Gwen O’Sullivan at gwen.osullivan@nuigalway.ie.

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