Matthew Schwede1, Robert Y Lee2, Hanjing Zhuo3, Kirsten N Kangelaris1, Alejandra Jauregui3, Kathryn Vessel3, Annika Belzer3, Thomas Deiss4, Michael A Matthay1,3,5, Kathleen D Liu1,3,5, Carolyn S Calfee1,3,5. 1. Department of Medicine, University of California, San Francisco, San Francisco, CA. 2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA. 3. Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA. 4. Department of Biochemistry & Biophysics, University of California, San Francisco, San Francisco, CA. 5. Department of Anesthesia, University of California, San Francisco, San Francisco, CA.
Abstract
OBJECTIVES: The acute respiratory distress syndrome is common in critically ill patients. Recognition is crucial because acute respiratory distress syndrome is associated with a high mortality rate, and low tidal volume ventilation improves mortality. However, acute respiratory distress syndrome often goes unrecognized. Risk factors for under-recognition and trends over time have not been fully described. DESIGN: Retrospective chart review of patients with acute respiratory distress syndrome from a prospective cohort study of critically ill patients. For each patient's ICU stay, we searched the chart for terms that indicated that acute respiratory distress syndrome was diagnosed, in the differential diagnosis, or treated with low tidal volume ventilation. SETTING: ICUs at a tertiary hospital at the University of California, San Francisco between 2008 and 2016. PATIENTS: Critically ill patients with acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Acute respiratory distress syndrome was recognized in 70% of patients, and recognition increased from 60% in 2008-2009 to 92% in 2016 (p = 0.004). Use of tidal volumes less than 6.5 mL/kg also increased (p < 0.001) from 20% to 92%. Increased acute respiratory distress syndrome severity (p = 0.01) and vasopressor use (p = 0.04) were associated with greater recognition. Clinician diagnosis of acute respiratory distress syndrome and inclusion of acute respiratory distress syndrome in the differential diagnosis were associated with tidal volumes less than 6.5 mL/kg (51% use of tidal volume ≤ 6.5 mL/kg if acute respiratory distress syndrome recognized vs 15% if not recognized; p = 0.002). Diagnosing acute respiratory distress syndrome was associated with lower tidal volume in multivariate analysis. CONCLUSIONS: Although acute respiratory distress syndrome recognition and low tidal volume ventilation use have increased over time, they remain less than universal. Clinician recognition of acute respiratory distress syndrome is associated with both systemic and respiratory severity of illness and is also associated with use of low tidal volume ventilation.
OBJECTIVES: The acute respiratory distress syndrome is common in critically illpatients. Recognition is crucial because acute respiratory distress syndrome is associated with a high mortality rate, and low tidal volume ventilation improves mortality. However, acute respiratory distress syndrome often goes unrecognized. Risk factors for under-recognition and trends over time have not been fully described. DESIGN: Retrospective chart review of patients with acute respiratory distress syndrome from a prospective cohort study of critically illpatients. For each patient's ICU stay, we searched the chart for terms that indicated that acute respiratory distress syndrome was diagnosed, in the differential diagnosis, or treated with low tidal volume ventilation. SETTING: ICUs at a tertiary hospital at the University of California, San Francisco between 2008 and 2016. PATIENTS: Critically illpatients with acute respiratory distress syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Acute respiratory distress syndrome was recognized in 70% of patients, and recognition increased from 60% in 2008-2009 to 92% in 2016 (p = 0.004). Use of tidal volumes less than 6.5 mL/kg also increased (p < 0.001) from 20% to 92%. Increased acute respiratory distress syndrome severity (p = 0.01) and vasopressor use (p = 0.04) were associated with greater recognition. Clinician diagnosis of acute respiratory distress syndrome and inclusion of acute respiratory distress syndrome in the differential diagnosis were associated with tidal volumes less than 6.5 mL/kg (51% use of tidal volume ≤ 6.5 mL/kg if acute respiratory distress syndrome recognized vs 15% if not recognized; p = 0.002). Diagnosing acute respiratory distress syndrome was associated with lower tidal volume in multivariate analysis. CONCLUSIONS: Although acute respiratory distress syndrome recognition and low tidal volume ventilation use have increased over time, they remain less than universal. Clinician recognition of acute respiratory distress syndrome is associated with both systemic and respiratory severity of illness and is also associated with use of low tidal volume ventilation.
Authors: Giacomo Bellani; John G Laffey; Tài Pham; Eddy Fan; Laurent Brochard; Andres Esteban; Luciano Gattinoni; Frank van Haren; Anders Larsson; Daniel F McAuley; Marco Ranieri; Gordon Rubenfeld; B Taylor Thompson; Hermann Wrigge; Arthur S Slutsky; Antonio Pesenti Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: Roy G Brower; Michael A Matthay; Alan Morris; David Schoenfeld; B Taylor Thompson; Arthur Wheeler Journal: N Engl J Med Date: 2000-05-04 Impact factor: 91.245
Authors: Curtis H Weiss; David W Baker; Shayna Weiner; Meagan Bechel; Margaret Ragland; Alfred Rademaker; Bing Bing Weitner; Abha Agrawal; Richard G Wunderink; Stephen D Persell Journal: Crit Care Med Date: 2016-08 Impact factor: 7.598
Authors: Laura J Spece; Kristina H Mitchell; Ellen S Caldwell; Stephanie J Gundel; Sarah E Jolley; Catherine L Hough Journal: J Crit Care Date: 2017-10-18 Impact factor: 3.425
Authors: Eddy Fan; Lorenzo Del Sorbo; Ewan C Goligher; Carol L Hodgson; Laveena Munshi; Allan J Walkey; Neill K J Adhikari; Marcelo B P Amato; Richard Branson; Roy G Brower; Niall D Ferguson; Ognjen Gajic; Luciano Gattinoni; Dean Hess; Jordi Mancebo; Maureen O Meade; Daniel F McAuley; Antonio Pesenti; V Marco Ranieri; Gordon D Rubenfeld; Eileen Rubin; Maureen Seckel; Arthur S Slutsky; Daniel Talmor; B Taylor Thompson; Hannah Wunsch; Elizabeth Uleryk; Jan Brozek; Laurent J Brochard Journal: Am J Respir Crit Care Med Date: 2017-05-01 Impact factor: 21.405
Authors: Alshimaa R Azab; Walid Kamal Abdelbasset; Saud M Alrawaili; Abbas Elbakry A Elsayed; Mohammed Ibrahim Hajelbashir; FatmaAlzahraa H Kamel; Maged A Basha Journal: Int J Environ Res Public Health Date: 2022-05-17 Impact factor: 4.614
Authors: V Eric Kerchberger; Ryan M Brown; Matthew W Semler; Zhiguo Zhao; Tatsuki Koyama; David R Janz; Julie A Bastarache; Lorraine B Ware Journal: Crit Care Explor Date: 2021-07-06