Skip to main content

Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study.

Publication ,  Journal Article
Qadir, N; Bartz, RR; Cooter, ML; Hough, CL; Lanspa, MJ; Banner-Goodspeed, VM; Chen, J-T; Giovanni, S; Gomaa, D; Sjoding, MW; Hajizadeh, N ...
Published in: Chest
October 2021

BACKGROUND: Although specific interventions previously demonstrated benefit in patients with ARDS, use of these interventions is inconsistent, and patient mortality remains high. The impact of variability in center management practices on ARDS mortality rates remains unknown. RESEARCH QUESTION: What is the impact of treatment variability on mortality in patients with moderate to severe ARDS in the United States? STUDY DESIGN AND METHODS: We conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and Pao2 to Fio2 ratio of ≤ 150 with positive end-expiratory pressure of ≥ 5 cm H2O, who were admitted to 29 US centers between October 1, 2016, and April 30, 2017. The primary outcome was 28-day in-hospital mortality. Center variation in ventilator management, adjunctive therapy use, and mortality also were assessed. RESULTS: A total of 2,466 patients were enrolled. Median baseline Pao2 to Fio2 ratio was 105 (interquartile range, 78.0-129.0). In-hospital 28-day mortality was 40.7%. Initial adherence to lung protective ventilation (LPV; tidal volume, ≤ 6.5 mL/kg predicted body weight; plateau pressure, or when unavailable, peak inspiratory pressure, ≤ 30 mm H2O) was 31.4% and varied between centers (0%-65%), as did rates of adjunctive therapy use (27.1%-96.4%), methods used (neuromuscular blockade, prone positioning, systemic steroids, pulmonary vasodilators, and extracorporeal support), and mortality (16.7%-73.3%). Center standardized mortality ratios (SMRs), calculated using baseline patient-level characteristics to derive expected mortality rate, ranged from 0.33 to 1.98. Of the treatment-level factors explored, only center adherence to early LPV was correlated with SMR. INTERPRETATION: Substantial center-to-center variability exists in ARDS management, suggesting that further opportunities for improving ARDS outcomes exist. Early adherence to LPV was associated with lower center mortality and may be a surrogate for overall quality of care processes. Future collaboration is needed to identify additional treatment-level factors influencing center-level outcomes. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03021824; URL: www.clinicaltrials.gov.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

October 2021

Volume

160

Issue

4

Start / End Page

1304 / 1315

Location

United States

Related Subject Headings

  • Ventilator-Induced Lung Injury
  • Vasodilator Agents
  • United States
  • Severity of Illness Index
  • Respiratory System
  • Respiratory Distress Syndrome
  • Respiration, Artificial
  • Quality of Health Care
  • Prone Position
  • Practice Patterns, Physicians'
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Qadir, N., Bartz, R. R., Cooter, M. L., Hough, C. L., Lanspa, M. J., Banner-Goodspeed, V. M., … Society of Critical Care Medicine’s Discovery Network, . (2021). Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study. Chest, 160(4), 1304–1315. https://doi.org/10.1016/j.chest.2021.05.047
Qadir, Nida, Raquel R. Bartz, Mary L. Cooter, Catherine L. Hough, Michael J. Lanspa, Valerie M. Banner-Goodspeed, Jen-Ting Chen, et al. “Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study.Chest 160, no. 4 (October 2021): 1304–15. https://doi.org/10.1016/j.chest.2021.05.047.
Qadir N, Bartz RR, Cooter ML, Hough CL, Lanspa MJ, Banner-Goodspeed VM, et al. Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study. Chest. 2021 Oct;160(4):1304–15.
Qadir, Nida, et al. “Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study.Chest, vol. 160, no. 4, Oct. 2021, pp. 1304–15. Pubmed, doi:10.1016/j.chest.2021.05.047.
Qadir N, Bartz RR, Cooter ML, Hough CL, Lanspa MJ, Banner-Goodspeed VM, Chen J-T, Giovanni S, Gomaa D, Sjoding MW, Hajizadeh N, Komisarow J, Duggal A, Khanna AK, Kashyap R, Khan A, Chang SY, Tonna JE, Anderson HL, Liebler JM, Mosier JM, Morris PE, Genthon A, Louh IK, Tidswell M, Stephens RS, Esper AM, Dries DJ, Martinez A, Schreyer KE, Bender W, Tiwari A, Guru PK, Hanna S, Gong MN, Park PK, Severe ARDS: Generating Evidence (SAGE) Study Investigators, Society of Critical Care Medicine’s Discovery Network. Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study. Chest. 2021 Oct;160(4):1304–1315.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

October 2021

Volume

160

Issue

4

Start / End Page

1304 / 1315

Location

United States

Related Subject Headings

  • Ventilator-Induced Lung Injury
  • Vasodilator Agents
  • United States
  • Severity of Illness Index
  • Respiratory System
  • Respiratory Distress Syndrome
  • Respiration, Artificial
  • Quality of Health Care
  • Prone Position
  • Practice Patterns, Physicians'