Acute respiratory distress syndrome: Underrecognition by clinicians

Fröhlich, Stephen; Murphy, Noelle; Doolan, Aoife; Ryan, Orla; Boylan, John F.

doi:10.1016/j.jcrc.2013.05.012

Cited by 57 publications

(55 citation statements)

References 24 publications

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“…Lack of recognition by treating clinicians may result in the appropriate treatment being commenced too late, or not at all. In a recent study, only 31·3% of patients who fulfilled both clinical and pathological diagnoses of ARDS had any mention of ARDS in their clinical notes (Fröhlich et al , ). The investigators concluded that not only is ARDS under‐recognized by clinicians in ICU but also that ARDS diagnosis does not result always in lower TV ventilation, as they found that those with a clinical diagnosis, when corrected for body weight, were ventilated with higher TV (6·8 versus 6·7 mL/kg) and had higher PEEP and mean airway pressures.…”

Section: Discussion – Implications For Practicementioning

confidence: 99%

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Optimal support techniques when providing mechanical ventilation to patients with acute respiratory distress syndrome

Parissopoulos

Mpouzika

Timmins

2015

Nursing in Critical Care

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It is important that nurses have underlying knowledge of both aetiology of ARDS and ventilation management, and that they monitor patients very closely. The adoption of a low tidal ventilation protocol, which is based on quality evidence guidelines, the value of rescue therapies and patient observation practices in the overall patient management, and the need to place emphasis on long-term patient outcomes, all these emerge as key factors for consideration and future research. However, there is also a need for more research that would explore the unique contribution of nurses in the management of this patient group, as it is difficult to discern this in the current literature.

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Section: Discussion – Implications For Practicementioning

confidence: 99%

“…However, among patients who receive low TV ventilation, mortality rates remain high, so additional treatments for ARDS are needed (Walkey et al, 2012). Reports also suggest that ARDS is still under-diagnosed in clinical practice (Fröhlich et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Optimal support techniques when providing mechanical ventilation to patients with acute respiratory distress syndrome

Parissopoulos

Mpouzika

Timmins

2015

Nursing in Critical Care

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“…In patients with known ARDS, lung protective ventilation has proven benefit (2, 3), but evidence suggests that many patients for which this therapy would be appropriate are not receiving it (4, 5). Whether a diagnosis of ARDS affects what therapies the patient receives is also unclear, emphasizing the need for further epidemiologic data on this condition.…”

Section: Ards and Acute Respiratory Failurementioning

confidence: 99%

Update in Critical Care Medicine: Evidence Published in 2016

Hepokoski

Malhotra

2017

Ann Intern Med

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“…For example, surveillance criteria may rely on objective documentation of mechanical ventilation as a respiratory organ dysfunction versus a clinical diagnosis of acute respiratory distress syndrome (ARDS), 21 as the latter may suffer from poor inter-rater, meta-, and test-re-test reliability. 22–25 This approach would promote benchmarking of doctors and hospital care of patients thought to be septic during routine clinical care. Audit may also occur across large populations of hospitals and patients, such that ease of measurement, cost, and burden gain importance.…”

Section: Audit and Quality Improvementmentioning

confidence: 99%

Application of a Framework to Assess the Usefulness of Alternative Sepsis Criteria

Seymour

Coopersmith

Deutschman

et al. 2016

Critical Care Medicine

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The current definition for sepsis is life-threatening, acute organ dysfunction secondary to a dysregulated host response to infection. Criteria to operationalize this definition can be judged by 6 domains of usefulness (reliability; content, construct and criterion validity, measurement burden, and timeliness). The relative importance of these 6 domains depends on the intended purpose for the criteria (clinical care, basic and clinical research, surveillance, or quality improvement (QI) and audit). For example, criteria for clinical care should have high content and construct validity, timeliness, and low measurement burden to facilitate prompt care. Criteria for surveillance or QI/audit place greater emphasis on reliability across individuals and sites and lower emphasis on timeliness. Criteria for clinical trials require timeliness to ensure prompt enrollment and reasonable reliability but can tolerate high measurement burden. Basic research also tolerates high measurement burden and may not need stability over time. In an illustrative case study, we compared examples of criteria designed for clinical care, surveillance and QI/audit among 396,241 patients admitted to 12 academic and community hospitals in an integrated health system. Case rates differed 4-fold and mortality 3-fold. Predictably, clinical care criteria, which emphasized timeliness and low burden and therefore used vital signs and routine laboratory tests, had the highest case identification with lowest mortality. QI /audit criteria, which emphasized reliability and criterion validity, used discharge information and had the lowest case identification with highest mortality. Using this framework to identify the purpose and apply domains of usefulness can help with the evaluation of existing sepsis diagnostic criteria and provide a roadmap for future work.

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Acute respiratory distress syndrome: Underrecognition by clinicians

Cited by 57 publications

References 24 publications

Optimal support techniques when providing mechanical ventilation to patients with acute respiratory distress syndrome

Optimal support techniques when providing mechanical ventilation to patients with acute respiratory distress syndrome

Update in Critical Care Medicine: Evidence Published in 2016

Application of a Framework to Assess the Usefulness of Alternative Sepsis Criteria

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