Mechanical Ventilation and ARDS in the ED: A Multicenter, Observational, Prospective, Cross-sectional Study

Brian M Fuller; Nicholas M Mohr; Christopher N Miller; Andrew R Deitchman; Brian J Levine; Nicole Castagno; Elizabeth C Hassebroek; Adam Dhedhi; Nicholas Scott-Wittenborn; Edward Grace; Courtney Lehew; Marin H Kollef

doi:10.1378/chest.14-2476

Back

Mechanical Ventilation and ARDS in the ED: A Multicenter, Observational, Prospective, Cross-sectional Study

Journal article

Open access

Peer reviewed

Mechanical Ventilation and ARDS in the ED: A Multicenter, Observational, Prospective, Cross-sectional Study

Brian M Fuller, Nicholas M Mohr, Christopher N Miller, Andrew R Deitchman, Brian J Levine, Nicole Castagno, Elizabeth C Hassebroek, Adam Dhedhi, Nicholas Scott-Wittenborn, Edward Grace, …

Chest, Vol.148(2), pp.365-374

08/2015

DOI: 10.1378/chest.14-2476

PMCID: PMC4524326

PMID: 25742126

Files and links (1)

url

https://doi.org/10.1378/chest.14-2476View

Published (Version of record) Open Access

Abstract

There are few data regarding mechanical ventilation and ARDS in the ED. This could be a vital arena for prevention and treatment. This study was a multicenter, observational, prospective, cohort study aimed at analyzing ventilation practices in the ED. The primary outcome was the incidence of ARDS after admission. Multivariable logistic regression was used to determine the predictors of ARDS. We analyzed 219 patients receiving mechanical ventilation to assess ED ventilation practices. Median tidal volume was 7.6 mL/kg predicted body weight (PBW) (interquartile range, 6.9-8.9), with a range of 4.3 to 12.2 mL/kg PBW. Lung-protective ventilation was used in 122 patients (55.7%). The incidence of ARDS after admission from the ED was 14.7%, with a mean onset of 2.3 days. Progression to ARDS was associated with higher illness severity and intubation in the prehospital environment or transferring facility. Of the 15 patients with ARDS in the ED (6.8%), lung-protective ventilation was used in seven (46.7%). Patients who progressed to ARDS experienced greater duration in organ failure and ICU length of stay and higher mortality. Lung-protective ventilation is infrequent in patients receiving mechanical ventilation in the ED, regardless of ARDS status. Progression to ARDS is common after admission, occurs early, and worsens outcome. Patient- and treatment-related factors present in the ED are associated with ARDS. Given the limited treatment options for ARDS, and the early onset after admission from the ED, measures to prevent onset and to mitigate severity should be instituted in the ED. ClinicalTrials.gov; No.: NCT01628523; URL: www.clinicaltrials.gov.

Multivariate Analysis

Emergency Service, Hospital

Prospective Studies

Respiration, Artificial - methods

Cross-Sectional Studies

Humans

Middle Aged

Logistic Models

Male

Respiratory Insufficiency - therapy

Disease Progression

Ventilator-Induced Lung Injury - prevention & control

Adult

Female

Aged

Cohort Studies

Respiratory Distress Syndrome, Adult - therapy

Details

Title: Subtitle: Mechanical Ventilation and ARDS in the ED: A Multicenter, Observational, Prospective, Cross-sectional Study
Creators: Brian M Fuller - Department of Emergency Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, MO; Department of Anesthesiology, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, MO. Electronic address: fullerb@wusm.wustl.edu
Nicholas M Mohr - Department of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
Christopher N Miller - Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH
Andrew R Deitchman - Department of Emergency Medicine, Christiana Care Health System, Newark, DE
Brian J Levine - Department of Emergency Medicine, Christiana Care Health System, Newark, DE
Nicole Castagno - University of Michigan Medical School, Ann Arbor, MI
Elizabeth C Hassebroek - Department of Critical Care Medicine, Mayo Clinic, Rochester, MN
Adam Dhedhi - Saint Louis University School of Medicine, St. Louis, MO
Nicholas Scott-Wittenborn - Washington University in St. Louis, St. Louis, MO
Edward Grace - Middlebury College, Middlebury, VT
Courtney Lehew - Department of Emergency Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, MO
Marin H Kollef - Division of Critical Care, and the Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, MO
Resource Type: Journal article
Publication Details: Chest, Vol.148(2), pp.365-374
DOI: 10.1378/chest.14-2476
PMID: 25742126
PMCID: PMC4524326
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Publisher: United States
Grant note: KL2 TR000450 / NCATS NIH HHS UL1 TR000448 / NCATS NIH HHS
Language: English
Date published: 08/2015
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984024533602771

Metrics

31 Record Views

54 Times Cited - Web of Science

See more details