Protocol failure detection: The conflation of acute respiratory distress syndrome, SARS-CoV-2 pneumonia and respiratory dysfunction

Lawrence A Lynn, Emily Wheeler, Russel Woda, Alexander B Levitov, Stanislaw P Stawicki, David P BahnerJournal of Emergencies, Trauma, and Shock 2021 14(4):227-231 In medicine, protocols are applied to assure the provision of the treatment with the greatest probability of success. However, the development of protocols is based on the determination of the best intervention for the group. If the group is heterogeneous, there will always be a subset of patients for which the protocol will fail. Furthermore, over time, heterogeneity of the group may not be stable, so the percentage of patients for which a given protocol may fail may change depending on the dynamic patient mix in the group. This was thrown into stark focus during the severe acute respiratory syndrome-2 coronavirus (SARS-CoV-2) pandemic. When a COVID-19 patient presented meeting SIRS or the Berlin Criteria, these patients met the criteria for entry into the sepsis protocol and/or acute respiratory distress syndrome (ARDS) protocol, respectively and were treated accordingly. This was perceived to be the correct response because these patients met the criteria for the “group” definitions of sepsis and/or ARDS. However, the application of these protocols to patients with SARS-CoV-2 infection had never been studied. Initially, poor outcomes were blamed on protocol noncompliance or some unknown patient factor. This initial perception is not surprising as these protocols are standards and were p...
Source: Journal of Emergencies, Trauma and Shock - Category: Emergency Medicine Authors: Source Type: research