BACKGROUND: Previous reports suggest that acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is underdiagnosed in both adult and pediatric clinical practice. Underrecognition of this condition may be a barrier to instituting a low tidal volume ventilation strategy. This study aimed to determine the accuracy of clinical diagnoses of ARDS in daily practice using the American European Consensus Conference (AECC) criteria as a criterion standard and to investigate whether clinical recognition of ARDS altered ventilator management. METHODS: This retrospective study included intensive care unit (ICU) patients who died and underwent postmortem examination. Two independent reviewers assigned each patient to those with ALI/ARDS or no ALI. For those who met AECC criteria for ARDS, all patient records were reviewed for the presence of a documented diagnosis of the condition. The accuracy of the clinicians in diagnosing ALI/ARDS was determined, and ventilator settings between the clinically "diagnosed" and "non-diagnosed" groups were compared. The diagnostic accuracy in predetermined subgroups (those with diffuse alveolar damage, with ≥3 affected chest x-ray quadrants, with diagnosis≥3 days, with pulmonary vs extrapulmonary cause) was also examined. RESULTS: Of 98 consecutive ICU patients who died and underwent autopsy, 51 met the inclusion criteria. Sixteen of 51 patients (31.3%) who had ALI/ARDS according to the AECC criteria had this recorded in their clinical notes. Those with histologic evidence of ALI/ARDS (diffuse alveolar damage) and with a more severe chest x-ray pattern or who satisfied the criteria for a number of consecutive days were no more likely to have a clinical diagnosis of ALI/ARDS recorded. However, those with a pulmonary cause of ALI/ARDS were more likely to have a diagnosis recorded. Tidal volumes, positive end-expiratory pressure, and mean airway pressure were higher in those with a clinical diagnosis of ARDS. CONCLUSIONS: Acute respiratory distress syndrome is underrecognized by clinicians in ICU, and recognition does not result in lower tidal volume ventilation. Significant barriers remain to the recognition of ALI/ARDS and application of an evidence-based ventilator strategy.
BACKGROUND: Previous reports suggest that acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is underdiagnosed in both adult and pediatric clinical practice. Underrecognition of this condition may be a barrier to instituting a low tidal volume ventilation strategy. This study aimed to determine the accuracy of clinical diagnoses of ARDS in daily practice using the American European Consensus Conference (AECC) criteria as a criterion standard and to investigate whether clinical recognition of ARDS altered ventilator management. METHODS: This retrospective study included intensive care unit (ICU) patients who died and underwent postmortem examination. Two independent reviewers assigned each patient to those with ALI/ARDS or no ALI. For those who met AECC criteria for ARDS, all patient records were reviewed for the presence of a documented diagnosis of the condition. The accuracy of the clinicians in diagnosing ALI/ARDS was determined, and ventilator settings between the clinically "diagnosed" and "non-diagnosed" groups were compared. The diagnostic accuracy in predetermined subgroups (those with diffuse alveolar damage, with ≥3 affected chest x-ray quadrants, with diagnosis≥3 days, with pulmonary vs extrapulmonary cause) was also examined. RESULTS: Of 98 consecutive ICU patients who died and underwent autopsy, 51 met the inclusion criteria. Sixteen of 51 patients (31.3%) who had ALI/ARDS according to the AECC criteria had this recorded in their clinical notes. Those with histologic evidence of ALI/ARDS (diffuse alveolar damage) and with a more severe chest x-ray pattern or who satisfied the criteria for a number of consecutive days were no more likely to have a clinical diagnosis of ALI/ARDS recorded. However, those with a pulmonary cause of ALI/ARDS were more likely to have a diagnosis recorded. Tidal volumes, positive end-expiratory pressure, and mean airway pressure were higher in those with a clinical diagnosis of ARDS. CONCLUSIONS: Acute respiratory distress syndrome is underrecognized by clinicians in ICU, and recognition does not result in lower tidal volume ventilation. Significant barriers remain to the recognition of ALI/ARDS and application of an evidence-based ventilator strategy.
Authors: Christopher W Seymour; Craig M Coopersmith; Clifford S Deutschman; Foster Gesten; Michael Klompas; Mitchell Levy; Gregory S Martin; Tiffany M Osborn; Chanu Rhee; David K Warren; R Scott Watson; Derek C Angus Journal: Crit Care Med Date: 2016-03 Impact factor: 7.598
Authors: Curtis H Weiss; David W Baker; Katrina Tulas; Shayna Weiner; Meagan Bechel; Alfred Rademaker; Angela Fought; Richard G Wunderink; Stephen D Persell Journal: Ann Am Thorac Soc Date: 2017-11
Authors: Neha N Goel; Clark Owyang; Shamsuddoha Ranginwala; George T Loo; Lynne D Richardson; Kusum S Mathews Journal: Respir Care Date: 2019-10-01 Impact factor: 2.258
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Authors: Ken Kuljit S Parhar; Karolina Zjadewicz; Gwen E Knight; Andrea Soo; Jamie M Boyd; Danny J Zuege; Daniel J Niven; Christopher J Doig; Henry T Stelfox Journal: Crit Care Explor Date: 2021-05-17