2003 OPEN FORUM Abstracts
Improved Compliance with a Low Tidal Volume Ventilation Strategy in ALI/ARDS
Parul Shah RRT, Allyson Callahan BS RRT, Nancy Collar BA RRT, Thomas Malinowski RRT, FAARC, James Lamberti MD. Inova Fairfax Hospital, Falls Church, VA.
Background: The Acute Respiratory Distress Syndrome Network (ARDS Net) published results 1 that clearly demonstrated that the application of a low tidal volume (VT) ventilation strategy could significantly reduce mortality in ALI/ARDS patients. In spite of the importance of the study, published reports have identified that academically oriented hospitals have not been rapid in applying the low tidal volume methodology 2,3. This poster describes the effectiveness of a community teaching hospital in applying a low tidal volume ventilation strategy in ALI/ARDS.
METHODS: We prospectively reviewed records of all patients in our adult ICU's to determine whether they met ALI/ARDS criteria (chest radiographs, PaO2/FiO2 ratio, and risk factor). Patients were reviewed, RCPs calculated the ideal body weight (IBW) on all patients who met these criteria, and then encouraged physicians to follow the ventilation protocol using 6cc/kg VT. We then compared our performance in 2002 to our data from 2001 to determine if there was any improvement in protocol application.
RESULTS: We doubled the number of patients managed with the ARDS-net protocol of low tidal volume strategy between 2001 (n=51) and 2002 (n=105). In addition, our present median tidal volume is within 1 ml/Kg of the published ARDSnet median value, and our plateau pressure is less than the ARDSnet median value.
CONCLUSIONS: Approximately 85% of the patients meeting ALI/ARDS definition are being managed with the ARDS-net protocol. The ARDS-net protocol can be applied in community teaching hospitals with levels of success exceeding that seen at other teaching facilities.
1. Acute Respiratory Distress Network. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Respiratory Distress Syndrome. N Engl J Med 2000; 342: 1301-8
2. Weinert C, Gross C, Marinelli W. Impact of Randomized Trials Results on Acute Lung Injury Ventilator Therapy in Teaching Hospitals. Am J Resp Care Crit Care Med. 2003; 167: 1304-1309
3. Rubenfeld G, Caldwell E, Hudson L. Publication of Study Results Does Not Increase Use of Lung Protective Ventilation in Patients with Acute Lung Injury. Am J Respir Crit Care Med 2001; 163: A295