Management of patient with acute respiratory distress syndrome (ARDS) is complex and management by a specialist with expertise in pulmonary mechanics may improve outcomes. We compared mechanical ventilation management of patients with ARDS by pulmonologists and surgeons.
We retrospectively reviewed 71 patients with a ICD-9 diagnosis of ARDS at two community hospitals. We collected information on demographics and all necessary parameters to calculate the APACHE II score. Outcomes included mortality and total days spent in the intensive care unit (ICU) and on mechanical ventilation for those that survived. All outcomes were adjusted for APACHE II score using multiple logistic regression.
Mechanical ventilation was managed by a pulmonologist in 44 patients and by a surgeon in 27 patients. Overall mortality was 40.3% (N=29). Patients managed by a pulmonologist had a lower mortality rate (34.1% vs. 48.2; p=0.24) and spent fewer days in the ICU (14.0 days vs. 19.5; p=0.16), although these differences were not statistically significant. These results were unaffected by adjustment for APACHE II score. However, days spent on mechanical ventilation was significantly lower in patients managed by pulmonologists (10.3 days vs. 19.0; p=0.04) and these results remained significant after adjustment for APACHE II score.
There were subtle differences in mortality, days spent in the ICU, and days spent on mechanical ventilation in patients with ARDS managed by either a pulmonologist or surgeon. However, sample size and the retrospective design limit our findings and further study in this area is needed.
F.M. Zeid, None.