Interventions to Optimize Survival and Recovery in Patients with ARDS

Many adult patients in the intensive care unit (ICU) are either admitted with a primary pulmonary diagnosis or a diagnosis putting them at risk for developing a pulmonary complication. These pulmonary issues can quickly devolve into acute respiratory distress syndrome (ARDS). It has been estimated that 10% to 15% of ICU patients and up to 23% of those who are receiving mechanical ventilatory support meet criteria for ARDS,¹ although ARDS is likely underrecognized and underreported.²

Our care of patients with ARDS has advanced immeasurably in the past several decades. Interventions include mechanical ventilation, sedation and paralysis, prone positioning, and extracorporeal membrane oxygenation (ECMO).^3–5 Mortality from ARDS has been noted to be decreasing over the past 20 years.² However, we still have much to learn about the direct management and supportive care we provide for these patients; there are still significant numbers of patients who are affected with long-term sequelae from ARDS, some of which may be a result of our interventions and treatments (ie, iatrogenic harm). For instance, mechanical ventilation itself can result in pulmonary damage⁵ and the overuse or underuse of sedation and pain medications and immobility may contribute to the development of muscle weakness and neuropsychiatric issues, sometimes lasting for months after ICU discharge.³