Acute Respiratory Distress Syndrome: Common, with Persistently Poor Outcomes

Summary and Comment |
March 10, 2016

Acute Respiratory Distress Syndrome: Common, with Persistently Poor Outcomes

  1. Patricia Kritek, MD

A study in 50 countries revealed poorly standardized care and high mortality.

  1. Patricia Kritek, MD

Although research into interventions for acute respiratory distress syndrome (ARDS) has risen, epidemiology and outcomes of patients with ARDS remain unclear. In this prospective cohort study, investigators enrolled 459 intensive care units (ICUs) from 50 countries, with the greatest representation from Europe; admissions and subsequent care were examined during 4 consecutive winter weeks in 2014.

Of nearly 30,000 ICU admissions, 10.4% were due to ARDS according to the Berlin ARDS definition (NEJM JW Hosp Med Sep 2012 and JAMA 2012; 307:2526). With that definition serving as the standard for ARDS, on-site clinicians underrecognized ARDS: They documented its presence in only 60% of cases overall and in 79% of severe cases. Among patients with ARDS, 35% received tidal volumes >8 mL/kg predicted body weight, with little difference across ARDS severities. For patients with severe ARDS, 38% underwent neuromuscular blockade, 16% were proned, 23% received steroids, and 13% were treated with pulmonary vasodilators. Mortality during 28 days ranged from 30% for patients with mild ARDS to 41% for those with severe disease.

Comment

This study gives us a snapshot of ARDS in 2014, mostly reflecting practice in Europe. Although it's possible that some clinicians recognized ARDS but didn't specifically document it, the syndrome probably remains substantially underrecognized. Most interesting is persistently high mortality despite recent advances in management. Tidal volumes remained high in many cases, and proning and neuromuscular blockade were not used in most patients, whereas treatments without randomized trial support (e.g., steroids, pulmonary vasodilators) were employed as frequently as these more rigorously studied interventions.

Editor Disclosures at Time of Publication

  • Disclosures for Patricia Kritek, MD at time of publication Speaker’s Bureau American College of Chest Physicians (Critical Care Board Review Course)

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Reader Comments (1)

bibiano Physician, Emergency Medicine, mexico

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