The Science Journal of the American Association for Respiratory Care

2001 OPEN FORUM Abstracts

PRELIMINARYOUTCOME DATA ON ACUTE LUNG INJURY (ALI) PATIENTS MANAGED WITH THE NIH ACUTERESPIRATORY DISTRESS SYNDROME (ARDS) NETWORK?S LOW TIDAL VOLUME (VT)VENTILATION PROTOCOL

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RH Kallet MS RRT,JM Luce MD, RM Jasmer MD, AR Campbell MD, J Tang MD Departments of Anesthesia,Surgery and Pulmonary Critical Care Medicine, San Francisco General Hospital(SFGH)

Background:The NIH ARDS Network trial compared traditional VT ventilation at12 mL/kg to 6 mL/kg and demonstrated a significant mortality reduction (39.8vs. 31% respectively) in ALI/ARDS patients. SFGH has commenced voluntary utilizationof this protocol to manage ALI/ARDS patients. We inquired whether a similarmortality rate could be reproduced when the ARDS Network study protocol wasutilized for clinical management.

Methods: We revieweddata on all ALI/ARDS patients managed clinically with the NIH ARDS Network protocolbetween September 2000 and June 2001. None of these patients was enrolled intoany ARDS Network study. Protocol initiation was at the discretion of the criticalcare services.

Results: 110ALI/ARDS patients were identified and 36 were managed clinically with the NIHARDS protocol. Subsequently, 3 patients were enrolled into an ongoing ARDS Networktrial and their data was excluded. ARDS Network exclusion criteria (i.e.: severechronic liver disease, chronic lung disease, acute brain injury, etc) were metin 12/33 patients with a subsequent mortality of 50%. Only LIS at protocol initiationdistinguished survivors from non-survivors (2.63 ± 0.47 vs. 3.0 ± 0.38 respectively;p = 0.035 by two-tailed, unpaired Mann-Whitney test.

Lung InjuryScore* 2.78 ± 0.46
APACHE II*20.1 ± 7.3
SAPS II*44.4 ± 14.2
Age43.7 ± 12.1years
ALI/ARDS VentDays before Protocol 1.3 ± 1.8days
Pulmonaryvs Non Pulmonary ALI/ARDS52% vs. 36%?
Hospital Mortality36% (12/33)
Mortalityadjusted for ARDS Net exclusions29% (6/21)

*based on N =33 and protocol implementation day; ? 12% Idiopathic ARDS

Conclusion:Our ALI/ARDS patients managed early in their disease course with the NIH ARDSNetwork ventilation protocol apparently had a similar mortality rate to theARDS Network study (once the data was controlled for most ARDS Network studyexclusion criteria). Our preliminary uncontrolled data are based upon a verysmall sample size. Therefore, our data should be interpreted with caution

 

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