Skip to main content
 

Main menu

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Archives
    • Most-Read Papers of 2022
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2023 Call for Abstracts
    • 2022 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal

User menu

  • Subscribe
  • My alerts
  • Log in

Search

  • Advanced search
American Association for Respiratory Care
  • Subscribe
  • My alerts
  • Log in
American Association for Respiratory Care

Advanced Search

  • Home
  • Content
    • Current Issue
    • Editor's Commentary
    • Archives
    • Most-Read Papers of 2022
  • Authors
    • Author Guidelines
    • Submit a Manuscript
  • Reviewers
    • Reviewer Information
    • Create Reviewer Account
    • Reviewer Guidelines: Original Research
    • Reviewer Guidelines: Reviews
    • Appreciation of Reviewers
  • CRCE
    • Through the Journal
    • JournalCasts
    • AARC University
    • PowerPoint Template
  • Open Forum
    • 2023 Call for Abstracts
    • 2022 Abstracts
    • Previous Open Forums
  • Podcast
    • English
    • Español
    • Portugûes
    • 国语
  • Videos
    • Video Abstracts
    • Author Interviews
    • Highlighted Articles
    • The Journal
  • Twitter
  • Facebook
  • YouTube
Research ArticleOriginal Research

Implementation of Protocolized Care in ARDS Improves Outcomes

Abhijit Duggal, Anupol Panitchote, Matthew Siuba, Sudhir Krishnan, Heather Torbic, Andrei Hastings, Omar Mehkri, Tarik Hanane, Umur Hatipoglu, R Duncan Hite and Eduardo Mireles-Cabodevila
Respiratory Care April 2021, 66 (4) 600-609; DOI: https://doi.org/10.4187/respcare.07999
Abhijit Duggal
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: [email protected]
Anupol Panitchote
Division of Critical Care Medicine, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Matthew Siuba
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sudhir Krishnan
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Heather Torbic
Department of Pharmacology, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Andrei Hastings
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Omar Mehkri
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tarik Hanane
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Umur Hatipoglu
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
R Duncan Hite
Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Eduardo Mireles-Cabodevila
Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Supplemental
  • References
  • Info & Metrics
  • PDF
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

BACKGROUND: Treatments for ARDS that improve patient outcomes include use of lung-protective ventilation, prone ventilation, and conservative fluid management. Implementation of ARDS protocols via educational programs might improve adherence and outcomes. The objective of this study was to investigate the effects of an ARDS protocol implementation on outcomes and adherence with ARDS guidelines.

METHODS: This was a single-center, interventional, comparative study before and after protocol implementation. Staff education for the ARDS protocol was implemented between June 2014 and May 2015. A retrospective cohort analysis was conducted during between January 2012 and May 2014 (pre-protocol) and between June 2015 and June 2017 (post-protocol). A total of 450 subjects with ARDS were included. After propensity score matching, 432 subjects were analyzed. Of those, 330 subjects were treated after protocol implementation.

RESULTS: The median (interquartile range [IQR]) plateau pressure and tidal volume over the first 3 d decreased significantly after protocol implementation (30.5 [IQR 24.2–33] vs 25.5 [IQR 21.7–30], P = .01 and 7.65 vs 7.4 mL/kg predicted body weight, P = .032, respectively). The percentage of subjects with unsafe tidal volume (> 10 mL/kg predicted body weight) decreased (14.4% vs 5.8%, P = .02). The percentage of subjects with safe plateau pressure (≤ 30 cm H2O) increased (47.4% vs 76.5%, P < .001). PEEP deviation from the ARDSNet PEEP/Embedded Image table was significantly lower after the implementation. Mortality at 28 and 90 days improved after implementation (53.9% vs 41.8% and 61.8% vs 48.2%, respectively). Adjusted odds ratios for 28-d and 90-d mortality were 0.47 (95% CI 0.28–0.78) and 0.45 (95% CI 0.27–0.76), respectively.

CONCLUSIONS: ARDS protocol implementation was associated with improved survival and rate of adherence.

  • acute respiratory distress syndrome
  • mechanical ventilation
  • gas exchange
  • lung protective ventilation
  • protocol implementation
  • propensity score matching

Footnotes

  • Correspondence: Abhijit Duggal MD MPH MSc, Department of Critical Care, Cleveland Clinic, 9500 Euclid Ave, L2-330, Cleveland, Ohio 44195. E-mail: duggala2{at}ccf.org
  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2021 by Daedalus Enterprises
View Full Text

Pay Per Article - You may access this article (from the computer you are currently using) for 1 day for US$30.00

Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.

Log in using your username and password

Forgot your user name or password?
PreviousNext
Back to top

In this issue

Respiratory Care: 66 (4)
Respiratory Care
Vol. 66, Issue 4
1 Apr 2021
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author

 

Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Association for Respiratory Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Implementation of Protocolized Care in ARDS Improves Outcomes
(Your Name) has sent you a message from American Association for Respiratory Care
(Your Name) thought you would like to see the American Association for Respiratory Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Implementation of Protocolized Care in ARDS Improves Outcomes
Abhijit Duggal, Anupol Panitchote, Matthew Siuba, Sudhir Krishnan, Heather Torbic, Andrei Hastings, Omar Mehkri, Tarik Hanane, Umur Hatipoglu, R Duncan Hite, Eduardo Mireles-Cabodevila
Respiratory Care Apr 2021, 66 (4) 600-609; DOI: 10.4187/respcare.07999

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Implementation of Protocolized Care in ARDS Improves Outcomes
Abhijit Duggal, Anupol Panitchote, Matthew Siuba, Sudhir Krishnan, Heather Torbic, Andrei Hastings, Omar Mehkri, Tarik Hanane, Umur Hatipoglu, R Duncan Hite, Eduardo Mireles-Cabodevila
Respiratory Care Apr 2021, 66 (4) 600-609; DOI: 10.4187/respcare.07999
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Introduction
    • Methods
    • Results
    • Discussion
    • Conclusions
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Supplemental
  • Info & Metrics
  • References
  • PDF

Related Articles

Cited By...

Keywords

  • Acute Respiratory Distress Syndrome
  • mechanical ventilation
  • gas exchange
  • lung protective ventilation
  • protocol implementation
  • propensity score matching

Info For

  • Subscribers
  • Institutions
  • Advertisers

About Us

  • About the Journal
  • Editorial Board

AARC

  • Membership
  • Meetings
  • Clinical Practice Guidelines

More

  • Contact Us
  • RSS
American Association for Respiratory Care

Print ISSN: 0020-1324        Online ISSN: 1943-3654

© Daedalus Enterprises, Inc.

Powered by HighWire