title: Mechanical ventilation management by pulmonologists and surgeons in patients with adult respiratory distress syndrome.
abstract: BACKGROUND
  Treatment of patients 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.
  
  
  METHODS
  We retrospectively reviewed 97 patients with an ICD-9 diagnosis of ARDS at 2 community hospitals. We collected information on demographics and all necessary parameters to calculate the acute physiology, age, and chronic health evaluation (APACHE II) score. Main outcomes included mortality and total days spent in the intensive care unit (ICU) and on mechanical ventilation. All outcomes were adjusted for APACHE II score using multiple logistic regression.
  
  
  RESULTS
  Mechanical ventilation was managed by a pulmonologist in 62 patients and by a surgeon in 35 patients. Mortality rate was 35.5% (n = 22) in the patients treated by pulmonologists and 45.7% (n = 16) in patients treated by surgeons (P = 0.32). This result was unaffected by adjustment for APACHE II score. However, those surviving spent fewer days in the ICU (median of 10 vs 16 days; P = 0.07) and fewer days on mechanical ventilation (median of 7 vs 15 days; P = 0.003) when treated by pulmonologists. These results were unaffected by adjustment for APACHE II score.
  
  
  CONCLUSIONS
  We found that patients who survived with ARDS spent fewer days on mechanical ventilation, and there was a trend for spending fewer days in the ICU when mechanical ventilation is managed by a pulmonologist compared with a surgeon. There was a lower mortality rate in the pulmonologist group, although this did not reach statistical significance. A small sample size and the retrospective design limit our findings. Further study using a multicenter design to determine if a disease specific specialist improves efficiency of care is needed because if our findings are confirmed, it would translate into significant cost savings.
authors.affiliation: Department of Medicine, Marshall University, Joan C. Edwards School of Medicine, Divisions of Pulmonary Medicine, Huntington, West Virginia 25701, USA.
authors.forename: Shadi
authors.initials: S
authors.lastname: Badin
authors.forename: Todd W
authors.initials: TW
authors.lastname: Gress
authors.forename: Nancy
authors.initials: N
authors.lastname: Munn
authors.forename: Fuad M
authors.initials: FM
authors.lastname: Zeid
mesh_terms: D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D012189:Retrospective Studies; D012907:Smoking; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome