LUNG SAFE: Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE

LUNG SAFE (Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE) is a multicentre, prospective, observational, 4-week inception cohort study, which has been carried out by the Acute Respiratory Failure section through the ESICM Trials Group. The study aimed to prospectively assess the burden of, management and therapeutic approaches to, and outcomes from acute hypoxaemic respiratory failure requiring ventilatory support, with a specific focus on ARDS as defined by the Berlin Definition.

LUNG SAFE Update (30/03/2018)

Publications from the LUNG SAFE study:

Bellani et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. February 23, 2016, Vol 315, No. 8.

Laffey et al. LUNG SAFE Investigators and the ESICM Trials Group. Potentially modifiable factors contributing to outcome from acute respiratory distress syndrome: the LUNG SAFE study. Intensive Care Med. 2016 Dec;42(12):1865-1876. Epub 2016 Oct 18.

Bellani et al, LUNG SAFE Investigators and the ESICM Trials Group. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. AJRCCM; Vol. 195, No. 1 | Jan 01, 2017 DOI:

Laffey et al. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study.  LUNG SAFE Investigators and the ESICM Trials Group. Lancet Respir Med. 2017 Aug;5(8):627-638. doi: 10.1016/S2213-2600(17)30213-8. Epub 2017 Jun 15. PMID: 28624388

Two pre-defined sub-studies have now also been published:

Goddard et al. The Randomised Educational Acute Respiratory Distress Syndrome Diagnosis Study: A Trial to Improve the Radiographic Diagnosis of Acute Respiratory Distress Syndrome. Crit Care Med. 2018 Feb 12. doi: 10.1097/CCM.0000000000003000. [Epub ahead of print]. PMID: 29438110

de Prost et al. Etiologies, diagnostic work-up and outcomes of acute respiratory distress syndrome with no common risk factor: a prospective multicentre study. Ann Intensive Care. 2017 Dec;7(1):69. doi: 10.1186/s13613-017-0281-6. Epub 2017 Jun 19. PMID: 28631088

A number of OPEN LUNG SAFE proposals have been completed, and manuscripts are currently under consideration for publication in different journals.

The list of currently approved OPEN LUNG SAFE Projects is as follows:

  1. Impact of Resolving versus confirmed ARDS.
  2. Assessing the effect of diabetes in ARDS or AHRF
  3. Use of tracheostomy among mechanically ventilated patients with severe ARDS
  4. Management and outcome of Acute respiratory failure in immunocompromised patients
  5. Hyperoxia, oxygenation levels and targets in Patients with Acute Hypoxic Respiratory Failure
  6. Hypercapnia and management of arterial CO2 tension in patients with ARDS
  7. Impact of spontaneous breathing in early ARDS
  8. Role of ECMO in LUNG SAFE database
  9. Risk factors for progression from MILD to more severe ARDS
  10. The influence of obesity in patients with ARDS or AHRF
  11. Impact of gender in patients with ARDS in LUNG SAFE
  12. Impact of acute renal failure in patients with ARDS in LUNG SAFE
  13. Impact of comorbidities in patients with ARDS in LUNG SAFE
  14. Prone position in ARDS in LUNG SAFE
  15. Novel indices of mechanical ventilation in patients with ARDS.
  16. Factors influencing severity of hypoxemia and associated mortality in Severe Acute Hypoxemic Respiratory Failure
  17. Barriers to low tidal volume ventilation.
  18. End of life care decisions for the patient with severe respiratory failure in ICU
  19. The characteristics of prolonged ventilation in patients with acute respiratory failure
  20. How patients with ARDS are weaned from PEEP
  21. Structure of ICU and risk standardised mortality ratio in acute hypoxemic respiratory failure
  22. Changes over time in response to therapeutic manoeuvres


Recognition and treatment of ARDS: The LUNG SAFE Study


John Laffey & Giacomo Bellani (23/02/16) ~ icTV interview on study findings

John Laffey & Giacomo Bellani (19/12/15) ~ icTV Update with PIs John Laffey and Giacomo Bellani 

John Laffey ~ icTV interview – LUNG SAFEOct 2013 icTV Update

Luciano Gattinoni ~ icTV interview – Utilising the ARDS Definition


OPEN LUNG SAFE Data Access, Publication and Authorship Policy


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