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Busiest ICUs Had Lowest Mortality, LOS for ARDS

PARIS, FRANCE — The busier ICUs are, the better they are at saving lives of patients with acute respiratory distress syndrome (ARDS).

That’s according to a presentation at the recent 2017 American Thoracic Society International Conference in Washington, DC.

Researchers from the Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumonologie et Réanimation Médicale in Paris compared death rates among high, moderate, and low-volume ICUs. Interestingly, they also reported that, among the 35 ICUs in the large French CUB-REA database, ICU mortality decreased even while ARDS severity increased.

"Our study is the first to look at a large and regional database that suggests patients with ARDS admitted to centers caring for large numbers of people with ARDS may have better prognoses than in centers with a lower case volume," explained lead author Martin Dres, MD. "We hope our research fuels further discussion regarding global quality of care and global management in the setting of ARDS."

Included in the study were CUB-REA data for 316,000 ICU stays occurring between 2000 and 2014. Researchers employed the SAPS2 scoring method to determine ARDS severity for patients admitted to the ICU, then tracked mortality rates based on patient volume.

Results indicate that 18,022 ICU stays between 2000 and 2014 were attributed to ARDS, with overall ICU prevalence of ARDS of 8.3%. That steadily rose from 6.5% in 2000 to 10.5% in 2008, before falling down to 7.2% in 2014, the study notes.

At the same time, SAPS2 severity scores increased from an average of 52 — which represented a predicted 50% mortality rate — to 58. Yet, ICU mortality slid down from 57.9% to 45.5% during the study period, and overall hospital mortality dropped from 59.1% to 48.4%.

High-volume ICUs had both the highest SAPS2 scores and the lowest mortality rates, at 51.5%, compared to 54% for moderate volume units and 55.2% for those with the lowest volume. The busiest ICUs also posted the lowest lengths of stay, according to the results.

"Further studies are warranted to confirm and delineate our results and determine whether regionalization of patients with ARDS should be recommended," Dres suggested.