Kathleen Vollman: ARDS Surviving & Thriving: early application of the evidence matters

There is no magic bullet that will reduce the mortality rate of the ARDS patients. It is the early and consistent applications of evidence-based supportive therapies that results in improve short and long-term outcomes. Understanding the ARDS Berlin definition that differentiates the syndrome based on severity of hypoxemia to be mild, moderate or severe, helps the experienced nurse target the correct supportive care. Our knowledge of the diffuse injury to the alveoli and capillary membranes caused by inflammatory mediators and ventilator-induced injury helps for greater understanding of the clinical signs/symptoms and why certain therapies support the ARDS patient better. Due to the complexity of the patient, it is critical that the skilled frontline nurse have a user-friendly structure (8 P’s) to trigger implementation of evidence based care practices. The goal is to PREVENT further injury of the lung, reduce ventilator-associated events and physical and cognitive decline. The team must utilize evidence-based ventilator strategies (PEEP) while ensuring adequate volume for the heart to work at maximum efficiency (PUMPS & PIPES) to help deliver oxygen to the tissue. The critical care nurse plays a key role in minimizing oxygen demand and balancing brain recovery through appropriate use of sedation and paralytic agents (PARALYSIS). The timing and implementation of the prone position (POSITIONING) can determine its effectiveness on oxygenation and prevention of lung injury.  Once prone position is no longer useful, early progressive is critical to improve long-term cognitive and functional ability. Appropriate nutrition (PROTIEN) to promote healing and reduce inflammation is an essential component of the care plan. Incorporating evidence based (Protocols) such as the ABCDEF can impact overall outcomes in the ICU patient.  It takes all our knowledge and skill to ensure the ARDS patient not only survives but is able to return to a meaningful life as soon as possible.