Optimizing Management of Acute Respiratory Distress Syndrome in Critically Ill Surgical Patients: A Systematic Review

Ruth Zagales; Philip Lee; Sanjan Kumar; Zachary Yates; Muhammad Usman Awan; Francis Cruz; Jacob Strause; Kathleen R Schuemann; Adel Elkbuli

doi:10.1016/j.jss.2024.10.039

Optimizing Management of Acute Respiratory Distress Syndrome in Critically Ill Surgical Patients: A Systematic Review

J Surg Res. 2025 Jan 3:305:385-397. doi: 10.1016/j.jss.2024.10.039. Online ahead of print.

Authors

Ruth Zagales¹, Philip Lee², Sanjan Kumar³, Zachary Yates³, Muhammad Usman Awan⁴, Francis Cruz⁵, Jacob Strause⁶, Kathleen R Schuemann⁷, Adel Elkbuli⁸

Affiliations

¹ Indiana University School of Medicine, Indianapolis, Indiana.
² University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii.
³ University of Central Florida College of Medicine, Orlando, Florida.
⁴ NOVA Southeastern University, Kiran Patel College of Allopathic Medicine, Fort Lauderdale, Florida.
⁵ University of Alabama School of Medicine, Birmingham, Alabama.
⁶ Florida International University, Herbert Wertheim College of Medicine, Miami, Florida.
⁷ Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida.
⁸ Division of Trauma and Surgical Critical Care, Department of Surgery, Orlando Regional Medical Center, Orlando, Florida; Department of Surgical Education, Orlando Regional Medical Center, Orlando, Florida. Electronic address: Adel.elkbuli@orlandohealth.com.

PMID: 39755005
DOI: 10.1016/j.jss.2024.10.039

Abstract

Introduction: This systematic review aims to evaluate the optimal management of acute respiratory distress syndrome (ARDS) in critically ill surgical patients, specifically focusing on positioning, extracorporeal membrane oxygenation (ECMO) use, ventilation, fluid resuscitation, and pharmacological treatments.

Methods: A systematic review was conducted utilizing four databases including PubMed, Google Scholar, EMBASE, and ProQuest. This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with The International Prospective Register of Systematic Reviews. Studies published until May 20, 2024, that assessed the management of ARDS in critically ill surgical adult populations were included in our review. The primary outcome of interest was mortality, with secondary outcomes like intensive care unit (ICU) length of stay (LOS), ventilator days, and oxygenation also being considered.

Results: A total of fifteen studies met inclusion criteria; four studies assessed positional interventions, four assessed treatments with ECMO, three assessed mechanical ventilation settings, and four assessed fluid resuscitation and medications. Prone position was found to decrease mortality, ICU LOS, ventilator days, and increased oxygenation (P < 0.001). ECMO utilization decreased the overall mortality rate when compared to patients without ECMO (36.4% versus 43.9%, P < 0.001). Maintaining a tidal volume ≤8 mL/kg body weight and plateau pressure ≤35 cm H₂O on mechanical ventilation also decreased patient mortality (P < 0.001). Finally, conservative fluid management decreased ICU LOS, whereas methylprednisolone use demonstrated decreased mortality.

Conclusions: Prone positioning, ECMO utilization, lung protective ventilation settings, and methylprednisolone reduced mortality among surgical patients with ARDS. In addition, prone positioning and conservative fluid management were associated with decreased ICU LOS, ventilator days, and improved oxygenation status.

Keywords: Acute respiratory distress syndrome; Critical care; Management; Patient outcomes; Surgical patients; Trauma patients.

Publication types

Review