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Mortality in acute respiratory distress syndrome (ARDS) patients remains unacceptable high, and there is substantial variation in the diagnostic and management strategies used. We recently established a standardized algorithm for the early identification and guideline conform therapy of ARDS on intensive care units (ICUs). We here present the results of a first-year observatory period after implementation of the ARDS bundle on our ICU.A retrospective, observative, single-center case control study over a period of 4 years was performed. We analyzed the effects after implementation of an ARDS standard operating procedure (SOP) on prevalence of the diagnosis ARDS, mortality from ARDS, and therapy strategies. Implementation of the SOP led to an increased frequency of ARDS diagnosis (P.05), increased application of early prone positioning (P.05), and use of neuromuscular blockers (P.02) in ARDS patients. An influence on mortality in ARDS patients could not be detected after implementation of the SOP (P = not significant).A standardized ARDS bundle fundamentally increases awareness of this clinical picture on ICU and facilitates application of evidence-based therapies like prone positioning and use of neuromuscular blockers. These data encourage evaluating our ARDS SOP in a prospective trial to identify potential effects on mortality.

Purpose Endotracheal intubation (ET) in intensive care unit (ICU) patients is regarded as more challenging than elective intubations in the operating room. Despite challenging conditions in ICU, trainees are often the initial operators performing ET. Because nonanesthesiologist intensivists with limited experience in ET run most of the nonsurgical ICUs, it is of exceptional importance to identify patients with predictable difficult ET in advance to prepare for a difficult airway scenario and thus avoid severe complications. Methods In this prospective, observational, single-center study, we used a truncated MACOCHA score to evaluate intubation performance of nonanesthesiologist ICU trainees in an interdisciplinary medical ICU. Results We show that ( a ) ET could be performed safely and without fatal complications in all cases; ( b ) the MACOCHA score is feasible on a nonanesthesiologist ICU; ( c ) a truncated MACOCHA score of at least 8 predicts failure of ICU trainees; and ( d ) availability of an ear, nose, and throat physician and an anesthesiologist is required to warrant successful management of difficult airways. Conclusion Our findings are a further step to implement the MACOCHA score into the standard admission procedure of an ICU to identify early those patients in whom additional support is needed in case of ET and to improve patient safety.

Early identification of acute respiratory distress syndrome (ARDS) and forceful implementation of standardized therapy algorithms are the mandatory basis of an effective therapy to improve patient outcome. Recently, a new definition of ARDS was implemented, which simplified the diagnostic criteria for ARDS. Evidence-based therapies are rare, but some cornerstone interventions can be recommended. Lung-protective ventilation with high positive end-expiratory pressure and low tidal volume and early prone positioning in severe cases improve survival rate. We here present an integrated "Dusseldorf hands-on translation" in the form of a "one-page" standard operating procedure in order to fasten and standardize both diagnosis and therapeutic algorithms on an intensive care unit.