OasisLMS

INTRODUCTION: Lung-protective ventilation (LPV) improves outcome in mechanically ventilated patients, especially when implemented early in the course of respiratory failure. Despite this, adherence to LPV is low. In 2013, we published a cohort study that demonstrated emergency department (ED) adherence to LPV was 27.1%. Median (IQR) tidal volume was 8.8 (7.8–10.0) mL/kg predicted body weight (PBW), and almost all patients received 100% fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) of 5 cm H2O. This prompted a clinical trial (LOV-ED Trial, 2017) which implemented LPV in the ED, and was associated with: 1) increase in LPV in both the ED and intensive care units (ICU); and 2) improved clinical outcomes. The objective of the current analysis was to assess ED-based LPV over the 5 years since our interventional trial, in order to assess intervention sustainability. METHODS: ED-based LPV was protocolized through strong collaboration with Respiratory Therapy, as part of our clinical trial. This included default tidal volume settings of 6-8 mL/kg PBW, initiating FiO2 at 0.30 – 0.40 (instead of 1.0) to limit hyperoxia, and PEEP setting with a PEEP-FiO2 table. In this current analysis, ventilator data from three prospective studies conducted at our center since 2017 were combined. LPV was defined as tidal volume ≤ 8 mL/kg PBW. Descriptive statistics were used to analyze data. Chi-square was used to compare ED LPV before and after implementation. RESULTS: 619 patients were included in the final analysis. Median tidal volume was 6.7 mL/kg PBW (6.2–7.3), FiO2 was 0.40 (0.40–0.80), and PEEP was 5 cm H2O (5–7.5). LPV was provided to 558 (90.1%) patients across the three studies after protocol implementation. This was significantly different (p < 0.01) compared to data from three cohort studies (n= 1,662) conducted before ED LPV implementation, which demonstrated ED LPV adherence in 760 (45.7%) patients. CONCLUSIONS: These data demonstrate that ED LPV is a sustainable intervention via protocolized implementation of ED ventilator settings and collaboration with Respiratory Therapy. Given the known patient-centered benefits of LPV, implementing through Respiratory Therapy during the earliest period of respiratory failure is likely a high fidelity intervention to improve quality and outcomes.