title: One-year experience with an acute respiratory distress syndrome standard operating procedure on intensive care unit.
abstract: OBJECTIVE
  Mortality in acute respiratory distress syndrome (ARDS) patients remains unacceptable high, and there is substantial variation in the diagnostic and management strategies used. We recently established a standardized algorithm for the early identification and guideline conform therapy of ARDS on intensive care units (ICUs). We here present the results of a first-year observatory period after implementation of the ARDS bundle on our ICU.
  
  
  RESULTS
  A retrospective, observative, single-center case control study over a period of 4 years was performed. We analyzed the effects after implementation of an ARDS standard operating procedure (SOP) on prevalence of the diagnosis ARDS, mortality from ARDS, and therapy strategies. Implementation of the SOP led to an increased frequency of ARDS diagnosis (P < .05), increased application of early prone positioning (P < .05), and use of neuromuscular blockers (P < .02) in ARDS patients. An influence on mortality in ARDS patients could not be detected after implementation of the SOP (P = not significant).
  
  
  CONCLUSIONS
  A standardized ARDS bundle fundamentally increases awareness of this clinical picture on ICU and facilitates application of evidence-based therapies like prone positioning and use of neuromuscular blockers. These data encourage evaluating our ARDS SOP in a prospective trial to identify potential effects on mortality.
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Luedike
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Totzeck
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Rammos
authors.affiliation: Division of Anaesthesiology, Medical Faculty Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany.
authors.forename: Detlef
authors.initials: D
authors.lastname: Kindgen-Milles
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty Heinrich-Heine-University, University Hospital Duesseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany. Electronic address: Tienush.Rassaf@uk-essen.de.
authors.forename: Tienush
authors.initials: T
authors.lastname: Rassaf
mesh_terms: D016022:Case-Control Studies; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D015995:Prevalence; D016684:Prone Position; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D009466:Neuromuscular Blocking Agents
keywords: ARDS; Berlin definition; Bundle; Guidelines; SOP