Research in context
Evidence before this study
We searched MEDLINE, Embase, CINAHL, and Web of Science with the terms (“mechanical ventilation”) AND (“ARDS” OR “acute respiratory distress syndrome”) AND (“high risk” OR “LIPS”), with no date or language restrictions. We excluded studies of patients not receiving mechanical ventilation and those in paediatric populations. We did not find any study specifically assessing mechanical ventilation and outcomes in patients according to their risk of acute respiratory distress syndrome (ARDS) based on the Lung Injury Prediction Score (LIPS). Findings of a study using the original LIPS database suggested that clinicians seemed to respond to ARDS with a low initial tidal volume (VT). Initial VT, however, was not associated with development of post-intubation ARDS or other outcomes. Nevertheless, this study assessed neither the proportion of patients at risk of ARDS nor possible differences in mechanical ventilation between this group of patients and those not at risk of ARDS.
Added value of this study
Our study is the first to focus specifically on the proportion of patients at risk of ARDS, ventilatory management of the disorder, and clinical outcomes, including pulmonary complications and mortality. Our study was prospective, with consecutive collection of data from patients and the inclusion of several intensive care units (ICUs) from different countries and continents, increasing its generalisability. We provided detailed descriptions of ventilatory parameters, pulmonary complications, and clinical outcomes. The proportion of patients at risk of ARDS was high, and clinical outcomes were worse in this subgroup than were those of patients not at risk of ARDS.
Implications of all the available evidence
Most patients on ventilation in the ICU do not have ARDS; however, a considerable number of individuals are at risk of this life-threatening complication. Early implementation of protective ventilation and other strategies in patients at risk of ARDS could be associated with better outcomes. Our results add to existing knowledge about epidemiological characteristics and outcomes of patients with ARDS, as described in the LUNG SAFE study, and could be useful in planning future studies and understanding previous findings about mechanical ventilation in patients in the ICU. Further refinements for prediction of ARDS are needed.