Does my patient really have ARDS?

Excerpt

A recent international observation study launched by the working group of the European Society of Intensive Care Medicine after the release of the new Berlin definition of ARDS has brought many important results [1]. One of the most surprising—and challenging—findings was the large amount of under-recognition by clinicians. Indeed, this study included all hypoxemic patients (PaO₂/FiO₂ ratio below 300 mmHg) under mechanical ventilation and the diagnosis was made automatically when criteria for the definition were fulfilled [2]. Both on admission and at discharge, the question was specifically asked whether the patient, at any time during the ICU stay, was qualified as having ARDS. Clinician recognition of ARDS ranged from only 51.3 % (95 % CI, 47.5–55.0 %) for mild ARDS to 78.5 % (95 % CI, 74.8–81.8 %) for severe ARDS. This had clear consequences since ventilatory settings were different in those with “unrecognized” ARDS. Not surprisingly, the patients with recognized ARDS were sicker in all categories. Interestingly also, the number of patients per physician or nurse in a given ICU negatively influenced this recognition. Therefore it seems important to understand why this syndrome is so often unrecognized (Fig. 1).

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