Hospital Variation in Management and Outcomes of Acute Respiratory Distress Syndrome due to Coronavirus 2019
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Pulmonary, Infection, 2022
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INTRODUCTION: Adherence to guideline-recommended ventilator management for acute respiratory distress syndrome (ARDS) due to COVID-19 is unknown. We sought to evaluate variation in use of ‘guideline-based care’ and adjunctive strategies for COVID-19 ARDS across 55 hospitals contributing to the Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry. We hypothesized that COVID-19 ARDS management would vary across hospitals and that hospital-level mortality would be higher at hospitals with lower use of guideline-recommended care as compared to those with higher use. METHODS: In this retrospective, observational study we used multivariable adjusted hierarchical random effects logistic regression to assess hospital-level, risk-adjusted use of ‘guideline-based care’ for ARDS, defined as low tidal volume (low Vt), plateau pressure (Pplat) < 30 cmH2O, and prone position for PaO2:FiO2 ratio (P:F) < 100. RESULTS: Among 2,021 patients with COVID-19 ARDS, 50% received care consistent with ARDS guidelines. After adjusting for demographic, geographic, time, and severity of illness characteristics, hospital of admission contributed to 20% of the risk-adjusted variation in 'guideline-based care’; a patient treated at a hospital with high utilization of recommended therapies had 2.3 times (95% CI 1.3-4.3) the odds of receiving ‘guideline-based care’ as compared to a patient receiving treatment at a randomly selected hospital with lower utilization of ‘guideline-base care.’ Additionally, there was significant hospital level variation in use of paralytics (MOR 4.0, 95% CI 1.6-10.1) and inhaled pulmonary vasodilators (MOR 3.9, 95% CI 1.5-10.2). Mortality was non-significantly lower at hospitals within the highest-use quartile of ‘guideline-based care’ as compared to the lowest-use quartile (risk-adjusted OR 0.5, 95% CI 0.2-1.1, p=0.06). CONCLUSIONS: Only half of patients studied in the international VIRUS registry received guideline-based ventilation strategies for COVID-19 ARDS, with wide variation across hospitals. Given the significant mortality risk associated with COVID-19 ARDS, there is room for improvement in implementation of guideline-recommended ventilator strategies.
Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Infection
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Acute Respiratory Distress Syndrome ARDS
Tag Ventilation
Tag COVID-19
Year 2022
Acute Respiratory Distress Syndrome
guideline-based treatments
mortality rate


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