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      American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma clinical protocol for management of acute respiratory distress syndrome and severe hypoxemia

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          Abstract

          Trauma patients are at risk for severe hypoxemia and acute respiratory distress syndrome (ARDS) and associated high morbidity and mortality. To optimize ARDS management in the injured patient, a consensus Clinical Trauma ARDS Protocol was developed for trauma centers.

          LEVEL OF EVIDENCE

          Therapeutic/Care Management: Level V.

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          Most cited references97

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          Acute respiratory distress syndrome: the Berlin Definition.

          V Ranieri, Gordon D Rubenfeld, B Taylor Thompson … (2012)
          The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
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            Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.

            Giacomo Bellani, John Laffey, Tài Pham … (2016)
            Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).
            Article 0 comments Cited 1696 times – based on 0 reviews     Review now
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              Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network.

              D Schoenfeld, R.G. Brower, F Paulus … (2000)
              Traditional approaches to mechanical ventilation use tidal volumes of 10 to 15 ml per kilogram of body weight and may cause stretch-induced lung injury in patients with acute lung injury and the acute respiratory distress syndrome. We therefore conducted a trial to determine whether ventilation with lower tidal volumes would improve the clinical outcomes in these patients. Patients with acute lung injury and the acute respiratory distress syndrome were enrolled in a multicenter, randomized trial. The trial compared traditional ventilation treatment, which involved an initial tidal volume of 12 ml per kilogram of predicted body weight and an airway pressure measured after a 0.5-second pause at the end of inspiration (plateau pressure) of 50 cm of water or less, with ventilation with a lower tidal volume, which involved an initial tidal volume of 6 ml per kilogram of predicted body weight and a plateau pressure of 30 cm of water or less. The primary outcomes were death before a patient was discharged home and was breathing without assistance and the number of days without ventilator use from day 1 to day 28. The trial was stopped after the enrollment of 861 patients because mortality was lower in the group treated with lower tidal volumes than in the group treated with traditional tidal volumes (31.0 percent vs. 39.8 percent, P=0.007), and the number of days without ventilator use during the first 28 days after randomization was greater in this group (mean [+/-SD], 12+/-11 vs. 10+/-11; P=0.007). The mean tidal volumes on days 1 to 3 were 6.2+/-0.8 and 11.8+/-0.8 ml per kilogram of predicted body weight (P<0.001), respectively, and the mean plateau pressures were 25+/-6 and 33+/-8 cm of water (P<0.001), respectively. In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a lower tidal volume than is traditionally used results in decreased mortality and increases the number of days without ventilator use.
              Article 0 comments Cited 1313 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jason A. Fawley
                Christopher J. Tignanelli
                Nicole L. Werner
                George Kasotakis
                Samuel P. Mandell
                Nina E. Glass
                David J. Dries
                Todd W. Costantini
                Journal
                Journal ID (nlm-ta): J Trauma Acute Care Surg
                Journal ID (iso-abbrev): J Trauma Acute Care Surg
                Journal ID (publisher-id): JT
                Title: The Journal of Trauma and Acute Care Surgery
                Publisher: Lippincott Williams & Wilkins
                ISSN (Print): 2163-0755
                ISSN (Electronic): 2163-0763
                Publication date (Print): October 2023
                Publication date (Electronic): 12 June 2023
                Volume: 95
                Issue: 4
                Pages: 592-602
                Affiliations
                From the Departments of Surgery of Scripps Health (J.F.), La Jolla, California; University of Minnesota (C.J.T.), Minneapolis, Minnesota; University of Wisconsin-Madison School of Medicine (N.W.), Madison, Wisconsin; Duke University School of Medicine (G.K.), Durham, North Carolina; University of Texas Southwestern (S.P.M.), Dallas, Texas; Rutgers-New Jersey Medical School (N.E.G.), Newark, New Jersey; Regions Hospital (D.J.D.), St. Paul, Minnesota; University of California (T.W.C.), San Diego, California; and University of Michigan, Ann Arbor (LMN), Michigan.
                Author notes
                [*]Address for correspondence: Lena M. Napolitano MD, FACS, FCCP, MCCM, University of Michigan, Ann Arbor, MI; email: lenan@ 123456umich.edu .
                Article
                Publisher ID: JT_230982 Accession ID: 00021
                DOI: 10.1097/TA.0000000000004046
                PMC ID: 10545067
                PubMed ID: 37314843
                SO-VID: c959f9c5-aded-4fb9-b222-2ac82614894f
                Copyright © Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                Date received : 12 March 2023
                Date revision received : 27 April 2023
                Date accepted : 28 April 2023
                Product

                Ann Arbor, Michigan

                Categories
                Subject: Independent Submission
                Custom metadata
                OPEN-ACCESS TRUE
                CME CME

                Keywords: acute respiratory distress syndrome,severe hypoxemia,low tidal volume ventilation,positive end-expiratory pressure,driving pressure,plateau pressure,recruitment maneuver,prone position,inhaled nitric oxide,neuromuscular blockade,extracorporeal membrane oxygenation
                Data availability:
                Keywords: acute respiratory distress syndrome, severe hypoxemia, low tidal volume ventilation, positive end-expiratory pressure, driving pressure, plateau pressure, recruitment maneuver, prone position, inhaled nitric oxide, neuromuscular blockade, extracorporeal membrane oxygenation

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