Evidence-Based Practices for Acute Respiratory Failure and Acute Respiratory Distress Syndrome

Abstract

BACKGROUND: The recent pandemic highlights the essential nature of optimizing the use of invasive mechanical ventilation (IMV) in complex critical care settings. This review of reviews maps evidence-based practices (EBPs) that are associated with better outcomes among adult patients with acute respiratory failure or ARDS on the continuum of care, from intubation to liberation. RESEARCH QUESTION: What EPBs are recommended to reduce the duration of IMV and mortality rate among patients with acute respiratory failure/ARDS? STUDY DESIGN AND METHODS: We identified an initial set of reports that links EBPs to mortality rates and/or duration of IMV. We conducted a review of reviews, focusing on preappraised guidelines, meta-analyses, and systematic reviews. We searched Scopus, CINAHL, and PubMed from January 2016 to January 2019 for additional evidence that has not yet been incorporated into current guidelines. RESULTS: Our initial search produced 61 publications that contained 42 EBPs. We excluded 42 manuscripts during the data extraction process, primarily because they were not associated with improved patient outcomes. The remaining 19 preappraised guidelines, meta-analyses, and systematic reviews met our full inclusion criteria and spanned the continuum of IMV care from intubation to liberation. These contained 20 EBPs, a majority of which were supported with moderate levels of evidence. Of these, six EBPs focused on intubation and escalation of care, such as ventilator management and synchrony; ten EBPs reduced complications associated with IMV, which included spontaneous awakening and breathing trials and early mobility protocols; and four EBPs promoted timely extubation and postextubation recovery. INTERPRETATION: This review describes EBPs that are associated with fewer ventilator days and/or lower mortality rates among patients who received IMV for acute respiratory failure/ ARDS. Many of these EBPs are connected across the care continuum, which indicates the need to promote and assess effective implementation jointly, rather than individually.

Effects of Stress Psychological Intervention on the Cardiopulmonary Function, Negative Emotion, Self-Efficacy, and Quality of Life in Patients with Acute Respiratory Failure

“…ARF is often caused by pulmonary and bronchial diseases and ventilatory dysfunction. It mostly occurs in middle-aged and elderly people and poses a serious threat to the life safety of patients [ 16 ]. Affected by a variety of factors, patients with ARF are prone to a series of negative emotions such as anxiety, depression, and tension and produce stress psychological reactions, thereby reducing the patients' treatment compliance.…”

The prevention of pressure injuries in the positioning and mobilization of patients in the ICU: a good clinical practice document by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)

“…Prolonged maintenance of the prone position for at least 12 h is associated with significantly reduced mortality in patients with acute respiratory distress syndrome (ARDS) [ 14 ]. Mortality is further reduced when prone positioning is combined with low current volume ventilation and when it is undertaken less than 48 h after the onset of the clinical condition [ 14 – 18 ].…”

“…An early mobilization protocol for ARDS patients undergoing invasive mechanical ventilation for more than 24 h resulted in a reduction in total mechanical ventilation time, with reduced frequency of adverse events. There was no significant improvement in mortality or functional status of the patient at discharge [ 14 , 44 , 45 ]. In contrast, it appears that early mobilization does not significantly affect the quality of life of critically ill patients with severe brain damage [ 46 ].…”

The Impact of Timing on Clinical and Economic Outcomes During Inter-ICU Transfer of Acute Respiratory Failure Patients: Time and Tide Wait for No One

“…Prior literature (7) has shown that patients with ARF have improved outcomes in high-volume/high-resource hospitals; however, it does not clarify if the patients have to be initially admitted to a high volume hospital or if they can be transferred from another hospital early in the course of their illness. A matched study of H1N1 patients with acute respiratory distress syndrome in the United Kingdom (45) revealed that patients had improved outcomes when referred to ECMO treatment centers even if they did not end up requiring ECMO, which brings up the question of not only timing of transfer but also early implementation of evidence-based best practices which are more likely to occur in high-volume/high-resource hospitals (46).…”