November 2017 NUI Galway Study Outlines the Need for Improved Recognition of Acute Respiratory Distress Syndrome

Professor John Laffey, Investigator at CÚRAM, the Science Foundation Ireland Centre for Research in Medical Devices and Professor of Anaesthesia and Intensive Care Medicine at NUI Galway, has published a paper in The British Medical Journal outlining strategies to improve recognition, awareness and diagnosis of Acute Respiratory Distress Syndrome (ARDS).

ARDS is an acute inflammatory lung injury, often caused by infection, which can result in respiratory failure. Around 40% of patients with ARDS do not survive, and others experience serious long-term health consequences. No drug treatments exist for ARDS, however good supportive management and careful support of organ function reduces harm and improves outcomes for patients.

ARDS is incorrectly considered to be rare, in particular by clinicians less familiar with intensive care units. Delayed or failed recognition of ARDS leads to delayed treatment or no treatment at all and under-recognition is linked to under treatment.

The LUNG SAFE study (29,000 patients in 459 intensive care units in 50 countries), which was jointly led by Professor Laffey, allowed for retrospective diagnosis of ARDS by researchers using clinical data, independent of the treating clinicians. The study reported that 40% of cases of ARDS were not recognised at any time during a patient’s stay in the intensive care unit. Delayed diagnosis was the norm, with less than 30% of patients diagnosed on the first day that criteria were present.

Although this evidence is new and compelling, the issue is not new, Professor Laffey, explains: “Failure to recognise ARDS leads to failure to use proven treatments, and this translates into higher chances of death, and a worse quality of life for patients who survive. Issues such as cognitive impairment, muscle wasting, and functional limitation in patients are some common consequences.”

Diagnosis of ARDS relies on recognising patterns in patients with evolving illness and receiving complex care. The interpretation of chest radiography in ARDS can be poor, and substantial inter-observer variation has been documented. Further difficulties arise with the lack of consensus around a definition of ARDS.

“Increased awareness of the condition among clinicians, patients and their relatives raises the likelihood of diagnosis. Over 20% of ventilated patients in intensive care units have ARDS, but it should be considered in any sick patient with respiratory distress, whether in the community, in an emergency department, or hospital ward. If we can detect these patients earlier, ideally on first presentation to the hospital, we can intervene earlier, and potentially improve outcome,” added Professor Laffey.

The co-authors of the study from the University of Toronto were Professor Brian Kavanagh and Professor Cheryl Misak, an ARDS survivor.

Evidence based strategies for improving outcomes for patients with ARDS are outlined in the paper, which is available at http://bmj.com/cgi/content/full/bmj.j5055.

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