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Reducing the Burden of Acute Respiratory Distress Syndrome: The Case for Early Intervention and the Potential Role of the Emergency Department

Fuller, Brian M.*; Mohr, Nicholas M.; Hotchkiss, Richard S.; Kollef, Marin H.§

doi: 10.1097/SHK.0000000000000142
Review Article
Editor's Choice

ABSTRACT The mortality for acute respiratory distress syndrome (ARDS) remains unacceptably high. Success in clinical trials has been limited, resulting in a lack of effective therapies to treat the syndrome. The projected increase in mechanically ventilated patients and global need for critical care services suggests that the clinical and research landscape in ARDS can no longer be confined to the intensive care unit. A demonstrable minority of patients present to the emergency department (ED) with ARDS, and ARDS onset typically occurs shortly after intensive care unit admission. Furthermore, the ED is an entry point for many of the highest-risk patients for ARDS development and progression. These facts, combined with prolonged lengths of stay in the ED, suggest that the ED could represent a window of opportunity for treatment and preventive strategies, as well as clinical trial enrollment. This review aims to discuss some of the potential strategies that may prevent or alter the trajectory of ARDS, with a focus on the potential role the ED could play in reducing the burden of this syndrome.

*Divisions of Critical Care and Emergency Medicine, Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri; Departments of Emergency Medicine and Anesthesiology, Division of Critical Care Roy J. and Lucille A. Carver College of Medicine, University of Iowa; Division of Critical Care, Department of Anesthesiology, and §Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Missouri

Received 16 Nov 2013; first review completed 3 Dec 2013; accepted in final form 13 Jan 2014

Address reprint requests to Brian M. Fuller, MD, MSCI, 660 S Euclid Ave, Campus Box 8072, St Louis, MO 63110. E-mail:

Sources of support: B.M.F. was supported by the Emergency Medicine Grant-in-Aid from the Division of Emergency Medicine, Washington University School of Medicine in St Louis, and the Postdoctoral Mentored Training Program in Clinical Investigation. This publication was made possible, in part, by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through grant UL1 TR000448. N.M.M. declares no support. R.S.H. was supported by NIH grants GM 44118 and GM 55194. M.H.K. was supported by the Barnes Jewish Hospital Foundation.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or any of the other supporting bodies.

Conflicts of interest: B.M.F., N.M.M., and M.H.K. declare no conflicts of interest. R.S.H. reports receiving grant support from MedImmune, Bristol-Myers Squibb, Agennix, and Aurigene.

© 2014 by the Shock Society