LUNG SAFE study group

LUNG SAFE study group
Name	LUNG SAFE study group
Caption	Multinational intensive care study
Date	2014
Location	Global
Type	Observational cohort study
Fields	Intensive care medicine, Pulmonology

Contents

LUNG SAFE study group

The LUNG SAFE study group conducted a large multinational observational investigation into acute respiratory distress syndrome and acute hypoxemic respiratory failure across intensive care units in 2014, informing debates among European Society of Intensive Care Medicine, Society of Critical Care Medicine, American Thoracic Society, World Health Organization, and national societies such as Society of Critical Care Medicine (United States), British Thoracic Society, European Respiratory Society. The project involved collaboration between academic centers at institutions like Massachusetts General Hospital, Brigham and Women’s Hospital, Johns Hopkins Hospital, Guy's and St Thomas' NHS Foundation Trust, Royal Brompton Hospital, Azienda Ospedaliero-Universitaria Careggi, and registries such as ICU Databases and consortia including ESICM Trials Group and SCCM Discovery Network.

Overview

The multinational study recruited patients from intensive care units in Europe, North America, South America, Asia, Africa, and Oceania and reported epidemiological data on incidence, recognition, management, and outcomes of acute respiratory distress syndrome during a defined study window, generating debate among stakeholders including New England Journal of Medicine, The Lancet Respiratory Medicine, JAMA, BMJ, The Lancet, and guideline panels from National Institute for Health and Care Excellence and World Health Organization advisory committees. The cohort was characterized using consensus criteria from the Berlin definition and cross-referenced with treatment modalities prominent in practice at centers such as St Thomas' Hospital, Mayo Clinic, Cleveland Clinic, Karolinska University Hospital, and Hospital Clínic de Barcelona.

The observational, prospective cohort design used point-prevalence methods, daily screening, and standardized case report forms created with input from experts affiliated with European Society of Intensive Care Medicine, Society of Critical Care Medicine, American Thoracic Society, and academic groups at University College London, Imperial College London, Université Paris Descartes, University of São Paulo, and Peking University Health Science Center. Patient inclusion criteria relied on arterial oxygenation and chest imaging interpretations aligned with the Berlin definition and care data documented using interventions such as mechanical ventilation, high-flow nasal cannula, and adjuncts like neuromuscular blockade and prone positioning, with outcomes tracked similarly to registries managed by ANZICS, NHS Digital, EuroSTAT, and institution-specific databases at Hospital das Clínicas, La Paz University Hospital, Charité – Universitätsmedizin Berlin, and Università degli Studi di Milano.

The study reported under-recognition of acute respiratory distress syndrome at bedside, variable use of lung-protective ventilation strategies such as low tidal volume consistent with trials from ARDSNet and inconsistent adoption of evidence-based interventions like prone positioning as in trials by Guerin et al. and adjunctive measures endorsed in manuscripts from ARDS Clinical Trials Network. Mortality, length of stay, and resource utilization findings intersected with policy discussions involving European Commission, Centers for Disease Control and Prevention, World Health Organization, and academic outlets including Intensive Care Medicine, Chest (journal), Critical Care Medicine, and American Journal of Respiratory and Critical Care Medicine, motivating guideline revisions at organizations like National Institute for Health and Care Excellence and influencing clinical pathways at centers including Mayo Clinic, Cleveland Clinic, Mount Sinai Health System, and Royal Melbourne Hospital.

The collaborative network encompassed university hospitals, regional hospitals, and academic centers across continents, with coordinating committees including investigators from Università degli Studi di Roma "La Sapienza", University of Toronto, University of Oxford, Harvard Medical School, University of Melbourne, Seoul National University Hospital, and King's College London. Governance and data management drew on expertise from consortia such as ESICM Trials Group, SCCM, ANZICS, and clinical research units affiliated with National Institutes of Health, European Research Council, and national research councils like CNPq and CNRS.

Critiques addressed potential selection bias, seasonality of point-prevalence design, variability in chest imaging interpretation across centers like Charité – Universitätsmedizin Berlin, Hospital Clínic de Barcelona, and Seoul National University Hospital, and concerns about generalizability raised in commentaries from editorial boards of The Lancet Respiratory Medicine, JAMA, and BMJ Open Access. Methodological debates referenced comparators such as randomized trials from ARDSNet, and systematic reviewers at institutions like Cochrane Collaboration and guideline panels at National Institute for Health and Care Excellence highlighted heterogeneity in data capture and the challenge of aligning observational findings with recommendations from bodies such as World Health Organization and European Society of Intensive Care Medicine.