Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial

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:10.1016/j.annemergmed.2017.01.013

Back

Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial

Journal article

Open access

Peer reviewed

Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial

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, …

Annals of emergency medicine, Vol.70(3), pp.406-418.e4

09/2017

DOI: 10.1016/j.annemergmed.2017.01.013

PMCID: PMC5573637

PMID: 28259481

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/5573637View

Open Access

Abstract

We evaluated the efficacy of an emergency department (ED)-based lung-protective mechanical ventilation protocol for the prevention of pulmonary complications. This was a quasi-experimental, before-after study that consisted of a preintervention period, a run-in period of approximately 6 months, and a prospective intervention period. The intervention was a multifaceted ED-based mechanical ventilator protocol targeting lung-protective tidal volume, appropriate setting of positive end-expiratory pressure, rapid oxygen weaning, and head-of-bed elevation. A propensity score-matched analysis was used to evaluate the primary outcome, which was the composite incidence of acute respiratory distress syndrome and ventilator-associated conditions. A total of 1,192 patients in the preintervention group and 513 patients in the intervention group were included. Lung-protective ventilation increased by 48.4% in the intervention group. In the propensity score-matched analysis (n=490 in each group), the primary outcome occurred in 71 patients (14.5%) in the preintervention group compared with 36 patients (7.4%) in the intervention group (adjusted odds ratio 0.47; 95% confidence interval [CI] 0.31 to 0.71). There was an increase in ventilator-free days (mean difference 3.7; 95% CI 2.3 to 5.1), ICU-free days (mean difference 2.4; 95% CI 1.0 to 3.7), and hospital-free days (mean difference 2.4; 95% CI 1.2 to 3.6) associated with the intervention. The mortality rate was 34.1% in the preintervention group and 19.6% in the intervention group (adjusted odds ratio 0.47; 95% CI 0.35 to 0.63). Implementing a mechanical ventilator protocol in the ED is feasible and is associated with significant improvements in the delivery of safe mechanical ventilation and clinical outcome.

Emergency Service, Hospital

Intensive Care Units

Prospective Studies

Respiration, Artificial - methods

Respiratory Distress Syndrome, Adult - physiopathology

Respiratory Rate

Patient Positioning

Humans

Middle Aged

Clinical Protocols

Male

Tidal Volume

Respiration, Artificial - instrumentation

Outcome and Process Assessment (Health Care)

Guideline Adherence

Female

Controlled Before-After Studies

Respiratory Distress Syndrome, Adult - therapy

Details

Title: Subtitle: Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial
Creators: Brian M Fuller - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: fullerb@wustl.edu
Ian T Ferguson - School of Medicine and Medical Science, University College Dublin, Dublin, 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, Iowa City, IA
Anne M Drewry - Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Christopher Palmer - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Brian T Wessman - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Enyo Ablordeppey - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Jacob Keeperman - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Robert J Stephens - Washington University School of Medicine in St. Louis, St. Louis, MO
Cristopher C Briscoe - Washington University School of Medicine in St. Louis, St. Louis, MO
Angelina A Kolomiets - School of Public Health and Social Justice, Saint Louis University, St. Louis, MO
Richard S Hotchkiss - Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Marin H Kollef - Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Resource Type: Journal article
Publication Details: Annals of emergency medicine, Vol.70(3), pp.406-418.e4
DOI: 10.1016/j.annemergmed.2017.01.013
PMID: 28259481
PMCID: PMC5573637
NLM abbreviation: Ann Emerg Med
ISSN: 0196-0644
eISSN: 1097-6760
Publisher: United States
Grant note: L30 HL115663 / NHLBI NIH HHS KL2 TR000450 / NCATS NIH HHS R01 GM044118 / NIGMS NIH HHS TL1 TR000449 / NCATS NIH HHS UL1 TR000448 / NCATS NIH HHS
Language: English
Date published: 09/2017
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984025270002771

Metrics

23 Record Views

76 Times Cited - Web of Science