How does your facility treat ARDS?

[ICUNurseStat]

I work in a 35 bed MICU. We seem to be VERY behind the times in treating ARDS. In the 3 years that I have worked on this particular unit, I think that we have pronated a total of 5 patients that I can recall, and always as an absolute last resort. I have seen one ocillator vent (although I'm not sure how much ocillator vents are used in the adult population even in more advanced facilities). As a guess, I would say that about 80% of our ARDS patients die in the end.

It seems that I read an article every week that highlights how far behind my facility is when it comes to EBP for treatment of ARDS. What things do you do for ARDS patients in your facility that seem to make a difference.

[beckster_01, BSN, RN]

Thank you, I was able to get my questions answered when I went back to work last night too, as they discussed these options in more detail during rounds. From what I understand he was too hemodynamically unstable for prone, and his original prognosis (before being hypoxic for 8hours) was too poor for an oscillator. At any rate, I'm only a year into ICU and wanted to make sure I hadn't missed anything. So much to learn still!

[Penelope_Pitstop, BSN, RN]

We've been on a proning kick lately. I'd say it works when it's done in time. Our unit doesn't do ECMO, but the one the floor below us does and we've sent people there for that reason. Those guys usually make it. But I think the intensivists are very realistic about who is a candidate. The people who survive are young ODs. Everyone who has a ton of comorbidities isn't even considered for it.

As for vent settings, we're big on pressure control. I like APRV but the docs don't seem to so we don't really see it.

[TraumaSurfer]

As for vent settings, we're big on pressure control. I like APRV but the docs don't seem to so we don't really see it.

Probably because APRV is not understood by physicians or even some RTs. There are too many set notions about certain modes so it is hard to grasp how APRV actually works. They understand it as just some sort of PC with PS. It is hard for some to use it properly with the extended inspiratory time and very short expiratory time. Some will still have horrible flashbacks to the days of Inverse I:E ratios from the 1980s and early 1990s. Some freak out when the low PEEP is recommended to be set at 0 on an ARDS patient. Some are also still caught up with the old textbooks where SIMV is the only mode which allows for "spontaneous" breathing. For a mode which has been around as long as it has, it is a same the textbooks and teachings have not caught up. But then some believe you NEVER, EVER give more than 2 Liters of oxygen to a COPD patient because you will "knock out the hypoxic drive" which gets quoted over and over by some RNs, RTs, EMTs and Paramedics.

Medicine and patients suffer when some don't want to let go of the way it always has been to move on with the new EBM.

[ICUPrincessNurse]

We try to prone early, HFOV as rescue only (we participated in the oscillate study that got shut down) and we use low tidal volumes on a/c volume control. Our docs are also big fans of super adequate sedation- "like a hot knife through butter." We have nitric but we haven't used it on an ARDS patient yet. Yet. Give it time and I'm sure it'll happen. At least on our MICU patients....

One of our SICU residents told me today that surgery patients never get ARDS... I told her they get it MORE than MI patients probably it just is never diagnosed. "Well, if it isn't diagnosed then it isn't true...."