Background of this project

Recent studies have shown that lung-protective ventilation (low tidal volume and airway pressure control), neuromusclular blocking agents, prone position, noninvasive mechanical ventilators, and extracorporeal membrane oxygenation (ECMO) have improved outcomes, including mortality, in patients with ARDS. However, the mortality of patients with ARDS is still as high as 40%. In addition, the complete reintegration ratio of patients with ARDS after 1 year of hospital discharge reported in 2003 was only 50%, and recent reports have shown little progress in this aspect. Strategies to improve outcomes (mortality and functional prognosis) of ARDS patients by improving not only treatment but also the quality of ICU care have become a hot topic in recent years. The previous paper showed that excessive sedation and absolute bed rest for the purpose of ventilation control and rest during intubation in ARDS patients correlated with delirium, prolonged duration of ventilation, and even increased mortality. Therefore, attempts have been explored to improve outcomes for ARDS patients by systematically providing sedation, analgesia, rehabilitation, spontaneous breathing and awaking tests, and delirium management during ICU admission. These attempts, known as the ABCDEF bundle, have been actively recommended by a number of academic societies to be introduced in ICUs as an attempt to improve the outcomes of patients with ARDS and promote their reintegration into society. (ABCDEF bundle: A (Assess, prevent, and manage pain), B (Both spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT)), C (Choice of analgesia and sedation), D (Delirium: assess, prevent, and manage), E (Early mobility and exercise), F (Family engagement and empowerment)), and even ICU care such as nutritional therapy and ICU diaries have been shown to improve outcomes for ICU patients, including ARDS, and are strongly recommended. (In this study, this ICU care is referred to as evidence-based ICU care.)

On the other hand, our research team has reported that the overall implementation rate of these evidence-based ICU care, ABCDEF bundles, nutritional therapy, and ICU diaries in ICU patients is quite low, and the rate is significantly lower in mechanically ventilated patients (16, 17). The reason for the low implementation rates is thought to be that the ventilator is a major barrier. Although many articles have proposed evidence-based ICU care, there is little evidence as to which of these should be prioritized and which should be combined to maximize patient outcomes. The reason for this may be that there is a lack of evidence on which of these should be prioritized and which should be combined to maximize patient outcomes. Implementation of evidence-based ICU care requires many resources and effort, and it is difficult to implement all of them simultaneously. Therefore, the purpose of this international multicenter study is to investigate the current epidemiology and treatment strategy given to the patients with ARDS after the two-year pandemic of the novel coronavirus, clarify the actual implementation of ICU care for ARDS patients who require ventilators at high frequency, and evaluate how the implementation of evidence-based ICU care is associated with patient outcomes.

(Reference)

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