Variation in Early Management Practices in Moderate-to-Severe ARDS in the United States: The Severe ARDS: Generating Evidence Study.
Adult
Aged
Cohort Studies
Early Medical Intervention
Extracorporeal Membrane Oxygenation
/ statistics & numerical data
Female
Glucocorticoids
/ therapeutic use
Guideline Adherence
/ statistics & numerical data
Hospital Mortality
Humans
Male
Middle Aged
Neuromuscular Blockade
/ statistics & numerical data
Patient Positioning
Positive-Pressure Respiration
Practice Guidelines as Topic
Practice Patterns, Physicians'
/ statistics & numerical data
Prone Position
Quality of Health Care
Respiration, Artificial
/ methods
Respiratory Distress Syndrome
/ therapy
Severity of Illness Index
United States
Vasodilator Agents
Ventilator-Induced Lung Injury
/ prevention & control
ARDS
corticosteroids
extracorporeal membrane oxygenation
mechanical ventilation
neuromuscular blockade
prone positioning
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
15
09
2020
revised:
03
05
2021
accepted:
10
05
2021
pubmed:
6
6
2021
medline:
11
1
2022
entrez:
5
6
2021
Statut:
ppublish
Résumé
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. What is the impact of treatment variability on mortality in patients with moderate to severe ARDS in the United States? We conducted a multicenter, observational cohort study of mechanically ventilated adults with ARDS and Pao A total of 2,466 patients were enrolled. Median baseline Pao 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. ClinicalTrials.gov; No.: NCT03021824; URL: www.clinicaltrials.gov.
Sections du résumé
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 Pao
RESULTS
A total of 2,466 patients were enrolled. Median baseline Pao
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.
Identifiants
pubmed: 34089739
pii: S0012-3692(21)01078-3
doi: 10.1016/j.chest.2021.05.047
pmc: PMC8176896
pii:
doi:
Substances chimiques
Glucocorticoids
0
Vasodilator Agents
0
Banques de données
ClinicalTrials.gov
['NCT03021824']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1304-1315Subventions
Organisme : NHLBI NIH HHS
ID : K01 HL136687
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL141596
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001421
Pays : United States
Investigateurs
Jay S Steingrub
(JS)
Mark Tidswell
(M)
Valerie M Banner-Goodspeed
(VM)
Kristin Brierley
(K)
Julia L Larson
(JL)
Ariel Mueller
(A)
Tereza Pinkhasova
(T)
Daniel Talmor
(D)
Imoigele Aisiku
(I)
Rebecca Baron
(R)
Lauren Fredenburgh
(L)
Alissa Genthon
(A)
Peter Hou
(P)
Anthony Massaro
(A)
Raghu Seethala
(R)
Abhijit Duggal
(A)
Duncan Hite
(D)
Ashish K Khanna
(AK)
Daniel Brodie
(D)
Irene K Louh
(IK)
Briana Short
(B)
Raquel Bartz
(R)
Mary L Cooter
(ML)
Jordan C Komisarow
(JC)
Anupama Tiwari
(A)
William Bender
(W)
James Blum
(J)
Annette Esper
(A)
Greg S Martin
(GS)
Eileen Bulger
(E)
Catherine L Hough
(CL)
Anna Ungar
(A)
Samuel M Brown
(SM)
Colin K Grissom
(CK)
Eliotte L Hirshberg
(EL)
Michael J Lanspa
(MJ)
Ithan D Peltan
(ID)
Roy G Brower
(RG)
Sarina K Sahetya
(SK)
R Scott Stephens
(RS)
Pramod K Guru
(PK)
John K Bohman
(JK)
Hongchuan Coville
(H)
Ognjen Gajic
(O)
Rahul Kashyap
(R)
John C O'Horo
(JC)
Jorge-Bleik Ataucuri-Vargas
(JB)
Jen-Ting Chen
(JT)
Michelle N Gong
(MN)
Fiore Mastroianni
(F)
Negin Hajizadeh
(N)
Jamie Hirsch
(J)
Michael Qui
(M)
Molly Stewart
(M)
Akram Khan
(A)
Ebaad Haq
(E)
Makrina Kamel
(M)
Olivia Krol
(O)
Kimberly Lerner
(K)
David J Dries
(DJ)
John Marini
(J)
Valentina Chiara Bistolfi Amaral
(VC)
Anthony Martinez
(A)
Harry L Anderson
(HL)
Jill Brown
(J)
Michael Brozik
(M)
Heidi Kemmer
(H)
Janet Obear
(J)
Nina Gentile
(N)
Kraftin E Shreyer
(KE)
Charles Cairns
(C)
Cameron Hypes
(C)
Josh Malo
(J)
Jarrod Mosier
(J)
Bhupinder Natt
(B)
Steven Y Chang
(SY)
Scott Hu
(S)
Ishan Mehta
(I)
Nida Qadir
(N)
Richard Branson
(R)
Dina Gomaa
(D)
Betty Tsuei
(B)
Sanjay Dhar
(S)
Ashley Montgomery-Yates
(A)
Peter Morris
(P)
Tina Chen
(T)
Sinan Hanna
(S)
Pauline K Park
(PK)
Michael W Sjoding
(MW)
Alfredo Lee Chang
(AL)
Perren Cobb
(P)
Janice M Liebler
(JM)
Estelle Harris
(E)
Nate Hatton
(N)
Gia Lewis
(G)
Stephen McKellar
(S)
Sanjeev Raman
(S)
Joseph Tonna
(J)
Ellen Caldwell
(E)
Sarah Dean
(S)
Shewit Giovanni
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021. Published by Elsevier Inc.
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