RT Journal Article
SR Electronic
T1 Implementation of Protocolized Care in ARDS Improves Outcomes
JF Respiratory Care
FD American Association for Respiratory Care
SP 600
OP 609
DO 10.4187/respcare.07999
VO 66
IS 4
A1 Abhijit Duggal
A1 Anupol Panitchote
A1 Matthew Siuba
A1 Sudhir Krishnan
A1 Heather Torbic
A1 Andrei Hastings
A1 Omar Mehkri
A1 Tarik Hanane
A1 Umur Hatipoglu
A1 R Duncan Hite
A1 Eduardo Mireles-Cabodevila
YR 2021
UL http://rc.rcjournal.com/content/66/4/600.abstract
AB 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/ 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.