2006 OPEN FORUM Abstracts
5 YEAR INCIDENCE AND OUTCOMES OF A LOW VOLUME VENTILATION PROTOCOL FOR ALI/ARDS PATIENTS.
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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.