title: [A multicenter clinical study of bundle treatment for moderate or severe acute respiratory distress syndrome].
abstract: OBJECTIVE
  To investigate the efficacy of bundle treatment on patients with moderate or severe acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  A multicenter prospective observational study comparing the result of historical treatment strategy and bundle treatment was conducted. According to the new Berlin standard of definition, 73 patients with moderate or severe ARDS due to pulmonary factors, age from 18 to 65 years, admitted to Department of Critical Care Medicine of Taian Central Hospital and Handan Central Hospital were enrolled. Thirty-three patients admitted during September 2012 to May 2014 (prospective observation period) were enrolled as the bundle treatment group. Forty patients with matched disease history admitted from January 2010 to August 2012 were enrolled as the control group. The patients in bundle treatment group received bundle treatment based on the treatment strategy of primary diseases. Bundle treatment included restrictive fluid management, respiratory support, high-dose ambroxol combined with Xuebijing injection, prevention of ventilation associated pneumonia (VAP), individualized sedation plan, installation of continuous blood purification treatment for critical patients. A special team was organized to ensure the successful implementation of all bundle measures. The acute physiology and chronic health evaluation II (APACHEII) score, oxygenation index, duration of mechanical ventilation, the length of intensive care unit (ICU) stay, incidence of VAP, and 28-day mortality 5 days after treatment were compared between two groups.
  
  
  RESULTS
  There were no significant differences in basic characteristics of patients between the two groups, including gender, age, etiology, severity, etc. (all P>0.05) with comparability. Compared with the control group, there was no significant difference in APACHE II score 5 days after treatment in bundle treatment group (15.1±2.8 vs. 16.2±3.0, t=1.618, P=0.110). Compared with control group, oxygenation index in bundle treatment group was significantly improved [mmHg (1 mmHg=0.133 kPa): 135.4±34.5 vs. 117.1±34.2, t=-2.273, P=0.026), the duration of mechanical ventilation was obviously reduced (days: 8.70±2.50 vs. 10.10±2.67, t=2.308, P=0.024), incidence of VAP was significantly lower [18.2% (6/33) vs. 32.5% (13/40), χ2=5.027, P=0.025], and 28-day mortality rate was obviously lowered [24.2% (8/33) vs. 37.5% (15/40), χ2=4.372, P=0.037], the length of ICU stay shown no statistical difference (days: 10.40±1.94 vs. 11.30±2.34, t=1.620, P=0.110).
  
  
  CONCLUSIONS
  Implementation of bundle treatment can significantly shorten the duration of mechanical ventilation, reduce the incidence of VAP, and improve the prognosis of patients.
authors.affiliation: Department of Critical Care Medicine, Affiliated Hospital of Taishan Medical University, Taian 271000, Shandong, China. Corresponding author: Wang Chunting, Department of Critical Care Medicine, Affiliated Provincial Hospital, Jinan 250021, Shandong, China, Email: wangchunting7051@126.com.
authors.forename: Maokui
authors.initials: M
authors.lastname: Yue
authors.forename: Furong
authors.initials: F
authors.lastname: Liu
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.forename: Fusen
authors.initials: F
authors.lastname: Zhang
authors.forename: Chunting
authors.initials: C
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D004365:Drugs, Chinese Herbal; D005440:Fluid Therapy; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome; D055815:Young Adult
chemical_list: D004365:Drugs, Chinese Herbal; C549376:Xuebijing