Mechanical ventilation and acute respiratory distress syndrome in the emergency department: a multi-center, observational, prospective, cross-sectional study.
Chest. 2015 Mar 5;
Authors: Fuller BM, Mohr NM, Miller CN, Deitchman AR, Levine BJ, Castagno N, Hassebroek EC, Dhedhi A, Scott-Wittenborn N, Grace E, Lehew C, Kollef MH
Background: There is little data regarding mechanical ventilation and acute respiratory distress syndrome (ARDS) in the emergency department (ED). This could be a vital arena for prevention and treatment.
Methods: Multi-center, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS after admission. Multivariable logistic regression was used to determine predictors of ARDS.
Results: We analyzed 219 mechanically ventilated patients to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight [PBW] (IQR, 6.9 - 8.9), with a range of 4.3 - 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 (55.7%) patients. The incidence of ARDS after admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the fifteen (6.8%) patients with ARDS in the ED, lung-protective ventilation was used in 7 (46.7%) patients. Patients that progressed to ARDS experienced greater duration in organ failure, ICU length of stay, and mortality.
Conclusions: Lung-protective ventilation is infrequent in mechanically ventilated ED patients, regardless of ARDS status. Progression to ARDS is common after admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset after admission from the ED, measures to prevent onset and mitigate severity should be instituted in the ED.
Clinical Trial Registration: ClinicalTrials.gov (NCT01628523).
PMID: 25742126 [PubMed - as supplied by publisher]