A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

Brian M Fuller; Ian T Ferguson; Nicholas M Mohr; Anne M Drewry; Christopher Palmer; Brian T Wessman; Enyo Ablordeppey; Jacob Keeperman; Robert J Stephens; Cristopher C Briscoe; Angelina A Kolomiets; Richard S Hotchkiss; Marin H Kollef

doi:10.1097/CCM.0000000000002268

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A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

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A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome

Brian M Fuller, Ian T Ferguson, Nicholas M Mohr, Anne M Drewry, Christopher Palmer, Brian T Wessman, Enyo Ablordeppey, Jacob Keeperman, Robert J Stephens, Cristopher C Briscoe, …

Critical care medicine, Vol.45(4), pp.645-652

04/2017

DOI: 10.1097/CCM.0000000000002268

PMCID: PMC5350028

PMID: 28157140

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Abstract

Objectives: To evaluate the impact of an emergency department mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome. Design: Quasi-experimental, before-after trial. Setting: Emergency department and ICUs of an academic center. Patients: Mechanically ventilated emergency department patients experiencing acute respiratory distress syndrome while in the emergency department or after admission to the ICU. Interventions: An emergency department ventilator protocol which targeted variables in need of quality improvement, as identified by prior work: 1) lung-protective tidal volume, 2) appropriate setting of positive end-expiratory pressure, 3) oxygen weaning, and 4) head-of-bed elevation. Measurements and main results: A total of 229 patients (186 preintervention group, 43 intervention group) were studied. In the emergency department, the intervention was associated with significant changes (p < 0.01 for all) in tidal volume, positive end-expiratory pressure, respiratory rate, oxygen administration, and head-of-bed elevation. There was a reduction in emergency department tidal volume from 8.1 mL/kg predicted body weight (7.0-9.1) to 6.4 mL/kg predicted body weight (6.1-6.7) and an increase in lung-protective ventilation from 11.1% to 61.5%, p value of less than 0.01. The intervention was associated with a reduction in mortality from 54.8% to 39.5% (odds ratio, 0.38; 95% CI, 0.17-0.83; p = 0.02) and a 3.9 day increase in ventilator-free days, p value equals to 0.01. Conclusions: This before-after study of mechanically ventilated patients with acute respiratory distress syndrome demonstrates that implementing a mechanical ventilator protocol in the emergency department is feasible and associated with improved clinical outcomes.

lung-protective ventilation

emergency department

ARDS

Details

Title: Subtitle: A quasi-experimental, before-after trial examining the impact of an emergency department mechanical ventilator protocol on clinical outcomes and lung-protective ventilation in acute respiratory distress syndrome
Creators: Brian M Fuller - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Ian T Ferguson - School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland
Nicholas M Mohr - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242
Anne M Drewry - Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis
Christopher Palmer - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Brian T Wessman - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Enyo Ablordeppey - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Jacob Keeperman - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Robert J Stephens - Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Cristopher C Briscoe - Washington University School of Medicine in St. Louis, St. Louis, MO 63110
Angelina A Kolomiets - School of Public Health and Social Justice, Saint Louis University, St. Louis, MO 63104
Richard S Hotchkiss - Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis
Marin H Kollef - Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis
Resource Type: Journal article
Publication Details: Critical care medicine, Vol.45(4), pp.645-652
DOI: 10.1097/CCM.0000000000002268
PMID: 28157140
PMCID: PMC5350028
NLM abbreviation: Crit Care Med
ISSN: 0090-3493
eISSN: 1530-0293
Language: English
Date published: 04/2017
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984024546302771

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