Acute respiratory distress syndrome
The authors review and summarize eight articles on Acute Respiratory Distress Syndrome (ARDS) to compare their clinical relevance. The variability and incidence of ARDS were perceived to differ across clinical settings across the world. These variances are mainly attributed to factors such as alterations in diagnosis, risk factors, the bias in clinical trials, and the inability to properly recognize the condition.
The authors’ analysis further showed that efforts to prevent the condition were futile, with medicines such as aspirins and statins failing to assist in randomized trials. On issues of treatment, glucocorticoids were identified as a viable model in the management of ARDS. Therefore, Confalonieri, Salton, and Fabiano (2017) note the inadequacies involving the clinical practice of the condition. The authors are affiliated with the pulmonary department of the University Hospital of Cattinara, hence, are knowledgeable about issues affecting the respiratory system. They present a variety of information from several sources, comparing the definition, diagnosis, and treatment of ARDS. This article provides the basis for arguments that call for increased efforts to enable better diagnosis and recognition of the condition in patients.
The role of red blood cells and cell-free hemoglobin in the pathogenesis of ARDS
Janz and Ware (2015) analyze the pathophysiology of ARDS with the underlying complications such as lung inflammation and pulmonary edema that increase morbidity and mortality in patients. Red blood cell (RBC) membranes become damaged due to sepsis in patients leading to lower transmission of oxygen to organs which causes their failure. Additionally, a study found that cell-free hemoglobin (CFH) played a critical role in ARDS in human beings. It showed that patients had higher levels of CFH, which led to instances of higher pulmonary artery pressures and pulmonary vascular resistance (Janz & Ware, 2015). The use of haptoglobin as a treatment regimen improved renal function in patients with ARDS, while acetaminophen can reduce oxidative injury. Cell-free hemoglobin in RBC, thus, shows signs of being a pathologic mediator of ARDS in human beings. Both authors work in departments of medicine and have the requisite expertise in matters concerning ARDS. Consequently, this article widens the perspective on the causes and effects of the condition to enable the development of appropriate therapies to directly target the affected regions of the chest cavity.
Formal guidelines: Management of acute respiratory distress syndrome
The authors note that the study conducted by LUNG SAFE showed the lack of recognition of ARDS in patients by approximately 40% of cases diagnosed by clinicians. Existing guidelines at the time were more than 20 years old, thus required an update due to evolving technology and knowledge in the field. The methodology used by the authors included the use of an expert working group specifically selected to research the guidelines (Papazian et al., 2019). Their reviews included a rating guided by a Grade of Recommendation Assessment, Development, and Evaluation (GRADE) procedure. Consequently, procedures showing a high level of proof were graded higher and strongly recommended for use while lower ones received lower ratings. The authors work in the various medical field ranging from emergency departments to intensive care units hence have witnessed first-hand cases of patients. The guidelines provided in this article enable better management of ARDS by primary care clinicians to avoid critical cases based on wrong diagnosis and treatment procedures.
Analysis
The article by Papazian et al. (2019) offers the most informative data due to its extensive coverage of the various recommendations and guidelines for managing ARDS in patients. The article provides the rating of each recommendation based on the analysis completed by a group of experts, thus, can help clinicians offer assistance through evidence-based practices that increase survivability. In cases where data is insufficient to give any professional opinions, the authors explicitly state the facts available and fail to make any recommendation. This shows their concentration on evaluating data based on its impact on the patients and the medical field. Therefore, the article is based on objective data not only to inform the masses but also to enhance service delivery for patients in health institutions. The article mainly targets individuals in the medical field, including clinicians and physicians, that directly deal with ARDS patients. Being informative in nature, it adds value by imparting knowledge previously unavailable in the field.
Furthermore, the length of the article also shows its attention to detail, with each guideline specifically discussed, culminating with a recommendation on its usage in the treatment and management of ARDS. The rationale for the selection requires complete agreement by a majority of the experts used in the study for a recommendation to achieve a high score. As a result, the GRADE methodology used implies the extensive use of scientific analysis to come up with the conclusions by the reviewing of secondary data previously used and available on ARDS. Additionally, the massive pool of authors highlights the vast knowledge base used to compile and review the information used in the article. Being experts in their fields, the analysis used provides viable, evidence-based information. Therefore, the article can be identified as a reliable source of medical data on ARDS that can be relied upon due to its accuracy.
References
Confalonieri, M., Salton, F., & Fabiano, F. (2017). Acute respiratory distress syndrome. European Respiratory Review, 26(144), 160116. Web.
Janz, D. R., & Ware, L. B. (2015). The role of red blood cells and cell-free hemoglobin in the pathogenesis of ARDS. Journal of Intensive Care, 3, 20. Web.
Papazian, L., Aubron, C., Brochard, L., Chiche, J.‑D., Combes, A., Dreyfuss, D.,… Faure, H. (2019). Formal guidelines: Management of acute respiratory distress syndrome. Annals of Intensive Care, 9(1), 69. Web.