The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

5 YEAR INCIDENCE AND OUTCOMES OF A  LOW VOLUME VENTILATION PROTOCOL FOR ALI/ARDS PATIENTS. 

- Tom Malinowski, RRT, FAARC, Monica Raich, RRT, Tom Arrowsmith, RRT, James Lamberti, MD. Inova Fairfax Hospital, Falls Church, VA.

Background: The Acute Respiratory Distress Syndrome Network (ARDS Net) published results in 2000 that demonstrated that the application of a low tidal volume (VT) ventilation strategy could significantly reduce mortality in Acute Lung Injury/Acute Respiratory Distress Syndrome (ALI/ARDS) patients. Recently published information projects the incidence of ALI/ARDS at 78.9 events/100,000 person years, or approximately 26% of all patients requiring mechanical ventilation. We describe the incidence and mortality of ALI/ARDS in adult patients requiring mechanical ventilation in a large, community teaching hospital while applying the low tidal volume ventilation protocol as described by the ARDS Network.

Methods: Retrospective review (May 2001-May 2006) of adult patients screened for ALI/ARDS criteria (chest radiographs, PaO2/FiO2 ratio, and risk factors) and whom were subsequently placed on a low tidal volume ventilation protocol incorporating 6ml/Kg target Vt and Pplat ≤ 30 cm H2O.

Results:
492 adults were both screened and placed on the ventilator protocol during this 5-year period.   This represents approximately 7% of adult patients requiring mechanical ventilation and excludes patients undergoing cardiac surgery. 

Year ICU Vent Days * ICU Vent episodes * ALI/ARDS protocol ALI/ARDS /Vent episodes Mortality %
2001 (Q2,3,4 only) 8195 994 40 4% 36%
2002 12133 1383 97 7% 45%
2003 12779 1462 78 5.3% 37%
2004 13038 1634 92 5.6% 33%
2005 11841 1766 136 7.7% 36%
2006 (Q1 only) 2312 363 49 13.5% 32%


*  excludes cardiac surgery patients

Conclusions: Two distinct components enhance low tidal volume application in this patient population: First is an enhanced recognition/diagnosis of ALI/ARDS.  Second is the application of the ventilator protocol.  The incidence of patients meeting ALI/ARDS criteria and subsequently being placed on the low tidal volume protocol continues to escalate in our institution, implying greater clinician recognition and awareness of the criteria.  In addition, the more frequent application of the protocol indicates a higher level of adoption by physician staff, once the diagnosis of ALI/ARDS has been made.


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