Journal article
The Practice Change and Clinical Impact of Lung-Protective Ventilation Initiated in the Emergency Department: A Secondary Analysis of Individual Patient-Level Data From Prior Clinical Trials and Cohort Studies
Critical care medicine, Vol.51(2), pp.279-290
02/2023
DOI: 10.1097/CCM.0000000000005717
PMCID: PMC10907984
PMID: 36374044
Abstract
OBJECTIVES Mechanically ventilated emergency department (ED) patients experience high morbidity and mortality. In a prior trial at our center, ED-based lung-protective ventilation was associated with improved care delivery and outcomes. Whether this strategy has persisted in the years after the trial remains unclear. The objective was to assess practice change and clinical outcomes associated with ED lung-protective ventilation. DESIGN Secondary analysis of individual patient-level data from prior clinical trials and cohort studies. SETTINGED and ICUs of a single academic center. PATIENTS Mechanically ventilated adults. INTERVENTIONS A lung-protective ventilator protocol used as the default approach in the ED. MEASUREMENTS AND MAIN RESULTS The primary ventilator-related outcome was tidal volume, and the primary clinical outcome was hospital mortality. Secondary outcomes included ventilator-, hospital-, and ICU-free days. Multivariable logistic regression, propensity score (PS)-adjustment, and multiple a priori subgroup analyses were used to evaluate outcome as a function of the intervention. A total of 1,796 patients in the preintervention period and 1,403 patients in the intervention period were included. In the intervention period, tidal volume was reduced from 8.2 mL/kg predicted body weight (PBW) (7.3-9.1) to 6.5 mL/kg PBW (6.1-7.1), and low tidal volume ventilation increased from 46.8% to 96.2% (p < 0.01). The intervention period was associated with lower mortality (35.9% vs 19.1%), remaining significant after multivariable logistic regression analysis (adjusted odds ratio [aOR], 0.43; 95% CI, 0.35-0.53; p < 0.01). Similar results were seen after PS adjustment and in subgroups. The intervention group had more ventilator- (18.8 [10.1] vs 14.1 [11.9]; p < 0.01), hospital- (12.2 [9.6] vs 9.4 [9.5]; p < 0.01), and ICU-free days (16.6 [10.1] vs 13.1 [11.1]; p < 0.01). CONCLUSIONS ED lung-protective ventilation has persisted in the years since implementation and was associated with improved outcomes. These data suggest the use of ED-based lung-protective ventilation as a means to improve outcome.
Details
- Title: Subtitle
- The Practice Change and Clinical Impact of Lung-Protective Ventilation Initiated in the Emergency Department: A Secondary Analysis of Individual Patient-Level Data From Prior Clinical Trials and Cohort Studies
- Creators
- Brian M Fuller - Washington University in St. LouisNicholas M Mohr - Roy J. and Lucille A. Carver College of MedicineEnyo Ablordeppey - Washington University in St. LouisOlivia Roman - Washington University in St. LouisDylan Mittauer - Washington University in St. LouisYan Yan - Washington University in St. LouisMarin H Kollef - Cooper University HospitalChristopher R Carpenter - Washington University in St. LouisBrian W Roberts - Washington University in St. Louis
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.51(2), pp.279-290
- DOI
- 10.1097/CCM.0000000000005717
- PMID
- 36374044
- PMCID
- PMC10907984
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Language
- English
- Electronic publication date
- 11/14/2022
- Date published
- 02/2023
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984315740902771
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