• Kate C Tatham, Niall D Ferguson, Qi Zhou, Lori Hand, Peggy Austin, Ravi Taneja, Alejandro C Arroliga, Juan F Sanchez, Edgar J Jimenez, Brandon P Staub, Michelle E Kho, J Guillermo Domínguez-Cherit, Adam Mullaly, Yaseen M Arabi, and Maureen O Meade.
• Department of Medicine, Division of Respirology & Critical Care Medicine, University Health Network and Sinai Health System, Toronto, Canada; Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery & Cancer, Imperial College, London, United Kingdom.
• J Crit Care. 2021 Oct 1; 65: 274281274-281.

PurposeWe sought to examine changes in acute respiratory distress syndrome (ARDS) management over a 12-year period of two successive randomized trials.MethodsAnalyses included baseline data, from eligible patients, prior to influence of trial protocols, and daily study data, from randomized patients, of variables not determined by trial protocols. Mixed linear regressions examined changes in practice year-on-year.ResultsA total of 2376 patients met the inclusion criteria. Over the 12-year period, baseline tidal volume index decreased (9.0 to 7.0 ml/kg, p < 0.001), plateau pressures decreased (30.8 to 29.0 cmH2O, p < 0.05), and baseline positive end-expiratory pressures increased (10.8 to 13.2 cmH2O, p < 0.001). Volume-controlled ventilation declined from 29.4 to 14.0% (p < 0.01). Use of corticosteroids increased (baseline: 7.7 to 30.3%; on study: 32.6 to 61.2%; both p < 0.001), as did neuromuscular blockade (baseline: 12.3 to 24.5%; on study: 55.5 to 70.0%; both p < 0.01). Inhaled nitric oxide use increased (24.9 to 65.8%, p < 0.05). We observed no significant change in prone positioning (16.2 to 18.9%, p = 0.70).ConclusionsClear trends were apparent in tidal volume, airway pressures, ventilator modes, adjuncts and rescue therapies. With the exception of prone positioning, and outside the context of rescue therapy, these trends appear consistent with the evolving literature on ARDS management.Copyright © 2021 Elsevier Inc. All rights reserved.

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