Researchers evaluated intensive care unit incidence and outcomes of acute respiratory distress syndrome to assess clinician recognition, ventilation management and use of adjunct interventions in routine clinical practice in a recent study published in JAMA.
The international, multicenter, prospective cohort study was conducted the winter of 2014, using a convenience sample of 459 ICUs from 50 countries across 5 continents. All total, the researchers identified 29,144 patients admitted to an ICU for invasive or noninvasive ventilation.
Highlighted below are seven findings from the study.
1. Of the more than 29,000 patients admitted to an ICU, 3,022 (10.4 percent) fulfilled ARDS criteria, which equals roughly 0.42 cases per ICU bed during the study period.
2. Of the patients that fulfilled ARDS criteria and whose respiratory failure was managed with invasive mechanical ventilation, 2,377 patients developed ARDS during the first 48 hours of admission.
3. The cases of ARDS were categorized by severity — 30 percent were mild, 46.6 percent were moderate and 23.4 percent were severe.
4. Clinical recognition of ARDS ranged from 51.3 percent in mild to 78.5 percent in severe ARDS.
5. The use of the adjunct intervention prone positioning was used in 16.3 percent of patients with severe ARDS.
6. Clinician recognition of ARDS was associated with higher positive end-expository pressure, greater use of neuromuscular blockade and prone positioning.
7. Hospital mortality was 34.9 percent for those with mild ARDS, 40.3 percent for moderate and 46.1 percent for severe cases.
"This syndrome appeared to be under-recognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS," concluded the study.
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