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Abstract

Introduction:The revised definition of Acute Respiratory Distress Syndrome in 2012 has been validated in mixed medical/surgical populations but the applicability to surgical patients has not been addressed. The surgical population differs from the medical population with recognized factors such as a postoperative atelectasis and volume overload secondary to aggressive resuscitation. This may contribute to over-diagnosis of ARDS in a surgical population. Methods: Prospective observational study of all ventilated patients admitted to the surgical intensive care unit of a tertiary care center over a 6 month time period. All patients were screened using a PaO2:FiO2 ratio and included if they met the remaining ARDS criteria. Chest radiographs were interpreted by a staff radiologist and trauma surgeon. Primary endpoints included incidence of ARDS and 30 day mortality. Secondary endpoints included reintubation rates. Results: 268 ventilated patients were admitted to the surgical intensive care unit, 141 (52.6%) of which met criteria for ARDS. On admission, 50 (35%) met criteria for mild ARDS, 48 (34%) had moderate ARDS, and 43 (30%) had severe ARDS. The overall mortality rate was 21% (n=31), 64% (n=20) of which were terminal weans. Including the terminal weans, the mortality rate for mild ARDS was 12% (n=6), moderate was 22% (n=11), and severe was 32% (n=14). 3 patients who underwent terminal weans had graduated from their ARDS criteria prior to expiration. The overall number of extubations was 96, 13 (13%) of which required reintubation. 6 patients (12%) with mild ARDS required reintubation, 2 patients(12.5%) with moderate ARDS, and 5 (17%) with resolved ARDS. Conclusions: Applying the Berlin Definition in our surgical population resulted in an ARDS incidence that is triple that quoted in current literature. This is not explained by patient accuity and is surmised to be related to changes in volume status and postoperative hypoxia. The reintubation rate for patients with mild ARDS is consistent with accepted reintubation rates in the critical care population without ARDS and the 30-day mortality rate for mild ARDS was significantly less than that in the 2012 AECC consensus statement, bringing into question the clinical significance of mild ARDS in the surgical population. The Berlin definition appears to be sensitive in the surgical population but the impact and prognostics of clinical care has not been elucidated.Introduction: Some providers assume that patients who have been previously intubated are more difficult to intubate should they require re-intubation. To our knowledge, no evidence exists to support this assumption. Methods: We analyzed a prospective database of consecutive intubations performed over 10 months in the emergency department, ICU, and inpatient floors at a single academic medical center. The database includes demographic variables and descriptive data regarding each procedure. Self-reported complications included arrhythmia, aspiration, airway injury, hypotension, hypoxia, esophageal intubation, ...