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Worldwide Study: ARDS Often Unrecognized, Inadequately Treated in ICUs

TORONTO -- Acute respiratory distress syndrome (ARDS) might be quite common, affecting more than 10% of intensive care patients around the world, but the deadly condition also is under-recognized and undertreated, according to a large study.

The research involving more than 450 ICUs in 50 countries on five continents was published recently in JAMA.

"We know that 40% of patients with ARDS die, either of this syndrome or their primary illness or injury, so this new, global understanding of this important public health issue and how we are treating it is enormously important for patients and clinicians," said lead author John Laffey, MD, chief anesthesiologist at St. Michael's Hospital in Toronto.

In ARDS, an uncontrolled inflammatory response damages the lining of the lungs, causing fluid to build up in the alveoli, reducing the amount of oxygen that reaches the bloodstream and usually requiring the use of artificial ventilation, according to background information in the article.

For the LUNG SAFE (Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE) study, conducted by the European Society of Intensive Care Medicine, enrolled 29,144 patients admitted to 459 ICUs in 2014. While 10.4% of ICU patients developed ARDS, about six patients per ICU bed per year, many – 40% -- were not diagnosed.

Mortality rates varied by severity of the condition, with 34%, 40.3% and 46.1% dying of mild, moderate and severe ARDS, respectively, according to the report.

Part of the problem, according to Laffey, is that no single test exists for diagnosing a syndrome made up of many symptoms.

The study also found the following:

  • Clinical recognition of ARDS ranged from 51.3% in mild to 78.5% in severe ARDS.
  • Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight.
  • Plateau pressure was measured in 40.1% patients, although 82.6% received a positive end-expository pressure (PEEP) of less than 12 cm H2O.
  • Prone positioning was used in 16.3% of patients with severe ARDS, even though that improves oxygenation.

The study also cited geographic differences in the recognition and treatment of ARDS, although those were not as large as they expected. The highest incidence of ARDS was in Australia and New Zealand, followed by Europe and North America, according to the report.

“This syndrome appeared to be under-recognized and undertreated and associated with a high mortality rate,” study authors said. “These findings indicate the potential for improvement in the management of patients with ARDS.”