The February 27, 2020 Department of Internal Medicine Medical Grand Rounds "Acute Respiratory Distress Syndrome (ARDS),” was presented by Marc Moss, MD, Roger S. Mitchell Professor of Medicine; head, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine.
Acute Respiratory Distress Syndrome (ARDS) “has been defined in a variety of different ways,” explained Moss. “Importantly, it is a syndrome and that means that we define it based on clinical criteria.” In 2012, the Berlin definition was created to streamline the diagnosis.
“What this new definition showed is that you can have new variations of ARDS based on hypoxemia, mild, moderate, or severe. In addition, you don’t need to be intubated for mild ARDS.”
How well do physicians do with identifying the disease? Moss cited a 2016 JAMA study which showed that ARDS is common in intensive care units (ICU) around the world, and almost 25% of patients on mechanical ventilation will meet criteria for ARDS. The disease is underrecognized by physicians and healthcare professionals. Of the patients with ARDS, only 60% had documentation in their chart that they actually had ARDS.
“We now have specific ways of treating ARDS, and if you are not recognizing ARDS, you aren’t treating people in the right way,” said Moss. “ARDS is ultimately a lung disease and it’s important for people to understand that. For example, when we talk about a disease such as the new COVID-19, we are talking about people dying from ARDS. Many people are not connecting that these diseases are all death from lung failure.”
Moss reviewed the risk factors for developing ARDS and methods for treating patients, such as prone positioning, extracorporeal membrane oxygenation (ECMO), and neuromuscular blockade dependent on the severity of the disease. He shared results from the ROSE trial, published in NEJM which showed no significant difference in 90-day mortality for “patients who received an early continuous cisatracurium infusion and those who were treated with a usual-care approach with lighter sedation targets.” Read the study here.
“One take home message is that there are things that we can do for patients with ARDS in the ICU: low tidal ventilation, PEEP strategies, prone positioning, intermittent neuromuscular blockade, and ECMO that we are not doing effectively and that is affecting the outcomes of our patients in not a good way,” concluded Moss.
To learn more about Moss’s presentation, review the video from Medical Grand Rounds.
The Section of Pulmonary, Critical Care and Sleep Medicine is one of the eleven sections within YSM’s Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM’s website, or follow them on Facebook and Twitter.