Development, implementation, and evaluation of a ketoconazole practice guideline for ARDS prophylaxis.

Area of Science:

• Critical Care Medicine
• Pharmacology
• Pulmonary Medicine

Background:

• Adult respiratory distress syndrome (ARDS) is a severe condition in critically ill patients.
• Current prevention strategies for ARDS have limitations.
• Ketoconazole has shown potential in ARDS prevention.

Purpose of the Study:

• To develop and implement a practice guideline for ketoconazole prophylaxis in high-risk ARDS patients.
• To evaluate the effectiveness of this guideline in a real-world clinical setting.
• To assess the impact of ketoconazole prophylaxis on ARDS incidence.

Main Methods:

• A practice guideline for ketoconazole prophylaxis was developed based on randomized trial evidence.
• The guideline was implemented in a study intensive care unit (ICU) through education and feedback.
• A concurrent control ICU without guideline implementation served as a comparison.
• Patient data were prospectively collected and analyzed.

Main Results:

• Implementation led to significantly increased ketoconazole use for ARDS prevention (P < .0001).
• The study hospital demonstrated a significantly lower incidence of ARDS compared to the control hospital (P < .05).
• No significant differences were observed in mortality, ventilation duration, or ICU length of stay.

Conclusions:

• A prophylactic ketoconazole practice guideline can be effectively developed and implemented in ICUs.
• This guideline is associated with increased ketoconazole use and reduced ARDS rates.
• Ketoconazole prophylaxis shows promise for ARDS prevention in high-risk critically ill patients.