Designing a better 'nest': Applicable to preventing hospital exposures to risk factors for acute respiratory distress syndrome or just retrospective study design?

摘要

The acute respiratory distress syndrome (ARDS) remains a common and important cause of morbidity and mortality in critically ill patients. Despite improved understanding of pathophysiology and numerous clinical trials targeting varied pathways of injury, current treatment is limited to lung-protective strategies of mechanical ventilation and other supportive care measures (1). The majority of patients do not present with ARDS but, instead, ARDS develops after admission (2, 3). In addition, epidemiologic data from Olmstead County, Minnesota, suggest that rates of ARDS have fallen over the past decade, largely due to reduced rates of "hospital-acquired" ARDS suggesting that the development of ARDS maybe partially preventable (3). Multiple prior studies have identified risk factors associated with the development of ARDS, such as medical and surgical misadventures, transfusions of blood products, higher tidal volume mechanical ventilation, inappropriate antibiotics, and delayed early goal-directed therapy of severe sepsis (4-10).