A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome.
A Quasi-Experimental, Before-After Trial Examining the Impact of an Emergency Department Mechanical Ventilator Protocol on Clinical Outcomes and Lung-Protective Ventilation in Acute Respiratory Distress Syndrome.
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DOI：
10.1097/ccm.0000000000002268
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发表时间：
2017-04
影响因子：
8.8
通讯作者：
Kollef MH
中科院分区：
文献类型：
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作者：
Fuller BM;Ferguson IT;Mohr NM;Drewry AM;Palmer C;Wessman BT;Ablordeppey E;Keeperman J;Stephens RJ;Briscoe CC;Kolomiets AA;Hotchkiss RS;Kollef MH
评价急诊科（艾德）机械通气方案对急性呼吸窘迫综合征（ARDS）患者临床结局和肺保护性通气依从性的影响。准实验性的，前后试验。学术中心的艾德和重症监护室（ICU）。机械通气艾德患者在艾德或入住ICU后发生ARDS。一项艾德呼吸机方案，其目标是需要质量改进的参数，如先前工作所确定的：1）肺保护潮气量; 2）适当设置呼气末正压（PEEP）; 3）氧气脱机;以及4）床头抬高。共229例患者（干预前组186例，干预组43例）接受了研究。在艾德中，干预与潮气量、PEEP、呼吸频率、给氧和床头抬高的显著变化相关（均P <0.01）。艾德潮气量从8.1 mL/kg PBW（7.0 - 9.1）减少到6.4 mL/kg PBW（6.1 - 6.7），肺保护性通气从11.1%增加到61.5%（P <0.01）。干预与死亡率从54.8%降至39.5%（OR 0.38，95%CI 0.17 - 0.83，P = 0.02）相关，无呼吸机天数增加3.9天，P = 0.01。这项对ARDS机械通气患者的前后研究表明，在艾德实施机械通气方案是可行的，并与改善的临床结局相关。
To evaluate the impact of an emergency department (ED) mechanical ventilation protocol on clinical outcomes and adherence to lung-protective ventilation in patients with acute respiratory distress syndrome (ARDS). Quasi-experimental, before-after trial. ED and intensive care units (ICU) of an academic center. Mechanically ventilated ED patients experiencing ARDS while in the ED or after admission to the ICU. An ED ventilator protocol which targeted parameters in need of quality improvement, as identified by prior work: 1) lung-protective tidal volume; 2) appropriate setting of positive end-expiratory pressure (PEEP); 3) oxygen weaning; and 4) head-of-bed elevation. A total of 229 patients (186 pre-intervention group, 43 intervention group) were studied. In the ED, the intervention was associated with significant changes (P < 0.01 for all) in tidal volume, PEEP, respiratory rate, oxygen administration, and head-of-bed elevation. There was a reduction in ED tidal volume from 8.1 mL/kg PBW (7.0 – 9.1) to 6.4 mL/kg PBW (6.1 – 6.7), and an increase in lung-protective ventilation from 11.1% to 61.5%, P < 0.01. The intervention was associated with a reduction in mortality from 54.8% to 39.5% (OR 0.38, 95% CI 0.17 – 0.83, P = 0.02), and a 3.9 day increase in ventilator-free days, P = 0.01. This before-after study of mechanically ventilated patients with ARDS demonstrates that implementing a mechanical ventilator protocol in the ED is feasible, and associated with improved clinical outcomes.