Respiratory failure & ventilation
Implementation of Lung-Protective Ventilation in Patients With Acute Respiratory Failure*
Authors' conclusion
We observed improved adherence to optimal ventilator management with implementation of a computerized protocol and reduction in the number of patients receiving tidal volumes greater than 8 mL/kg. We did not observe improvement in clinical outcomes.
Study context
- Population
- Adults ≥18 y with mechanical ventilation initiated in the ED or ICU, with and without acute respiratory distress syndrome (ARDS), 12 hospitals of an integrated healthcare system3,282 (38%) with ARDS
- Participants
- 8,692 adults
- Comparison
- After vs before implementation of a computerized low tidal volume ventilation (LTVV) protocol
- Outcome
- Ventilator-free days (VFDs); primary process outcome: median initial set tidal volume
- Follow-up
- Day 28
Methodological detailspragmatic, nonrandomized, multicentre (12 hospitals)
- Pragmatic
- Nonrandomized
- Multicentre (12 hospitals)
Main finding
As reported in the abstract
VFDs to day 28
No difference in VFD
1.06
aOR 1.06; 95% CI 0.91–1.24p = 0.44
Secondary outcomes
Initial set tidal volume (primary process outcome)
- Decreased from median 6.1 mL/kg (IQR 6.0-6.8) to 6.0 mL/kg (IQR 6.0-6.6) after implementation; p = 0.009
- mL/kg predicted body weight
Patients receiving LTVV (tidal volume ≤ 6.5 mL/kg)
- Increased from 69.8% (n = 1,721) to 72.5% (n = 1,846) after implementation; p = 0.036
Patients receiving >8 mL/kg initial set tidal volume
- Reduced from 9.0% (n = 222) to 6.7% (n = 174) after implementation; p = 0.005
Day 1 PEEP (ARDS subgroup)
- Increased from 6.7 to 8.0 cm H 2 O; p < 0.001
LOS and mortality (main cohort and ARDS subgroup)
- No difference in LOS or mortality, in the main cohort or the ARDS subgroup
Original publication
Implementation of Lung-Protective Ventilation in Patients With Acute Respiratory Failure*. Crit Care Med. Published 29 March 2023. doi:10.
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