The Sustainability of Lung-Protective Ventilation in the Emergency Department: A 5-Year, Single-Center Experience
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Pulmonary, Quality and Patient Safety, 2022
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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.
Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Quality and Patient Safety
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Respiratory Failure
Tag Evidence Based Medicine
Year 2022
lung protective ventilation
emergency department
clinical outcomes
sedation in the ED


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