S. Kumar1, Z. Yates1, A. Elkbuli1 1Orlando Regional Medical Center, Orlando, FL, USA
Introduction:
This systematic review aims to evaluate the optimal management of ARDS in critically ill surgical patients, specifically focusing on positioning, ECMO use, ventilation, fluid resuscitation, and pharmacologics.
Methods:
A systematic review was conducted utilizing four databases including PubMed, Google Scholar, EMBASE, and ProQuest. This study followed PRISMA guidelines and was registered with PROSPERO. Studies published until May 20th, 2024 that assessed the management of ARDS in critically ill surgical adult populations were included in our review. The primary outcome of interest was mortality, with secondary outcomes like ICU length of stay, ventilator days, and oxygenation also being considered.
Results:
A total of 15 studies met inclusion criteria; four studies assessed positional interventions, four assessed treatment with ECMO, three assessed mechanical ventilation settings, and four assessed fluid resuscitation and pharmacologics. Prone position was found to decrease mortality, ICU length of stay, ventilator days, and increased oxygenation (p<0.001). ECMO utilization decreased overall mortality rate when compared to patients without ECMO (36.4% vs 43.9%, p<0.001). Maintaining a tidal volume ≥ 8 mL/kg body weight and plateau pressure ≥ 35 cm H2O on mechanical ventilation also decreased patient mortality (p<0.001). Finally, conservative fluid management decreased ICU length of stay whereas methylprednisolone use demonstrated improved mortality.
Conclusion:
Prone positioning, ECMO utilization, lung protective ventilation settings, and methylprednisolone reduced mortality among surgical patients with ARDS. Additionally, prone positioning and conservative fluid management were associated with decreased ICU length of stay, ventilator days, and improved oxygenation status.