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Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with
Richard H Kallet1, Robert M Jasmer, Jean-Francois Pittet
1Department of Anesthesia, University of California, San Francisco at San Francisco General Hospital, California, USA.
Objective:
To assess the impact of implementing a low tidal volume ventilation strategy on hospital mortality for patients with acute lung injury or acute respiratory distress syndrome.
Design:
Retrospective, uncontrolled study.
Setting:
Adult medical-surgical and trauma intensive care units at a major inner city, university-affiliated hospital.
Patients:
A total of 292 patients with acute lung injury or acute respiratory distress syndrome.
Interventions:
Between the years 2000 and 2003, 200 prospectively identified patients with acute lung injury/acute respiratory distress syndrome were managed by the ARDS Network low tidal volume protocol. A historical control group of 92 acute respiratory distress syndrome patients managed by routine practice from 1998 to 1999 was used for comparison.
Measurements And Main Results:
Patients managed with the ARDS Network protocol had a lower hospital mortality compared with historical controls (32% vs. 51%, respectively; p = .004). Multivariate logistic regression estimated an odds ratio of 0.32 (95% CI, 0.17-0.59; p = .0003) for mortality risk with use of the ARDS Network protocol. Protocol-managed patients had a lower tidal volume (6.2 +/- 1.1 vs. 9.8 +/- 1.5 mL/kg; p < .0001) and plateau pressure (27.5 +/- 6.4 vs. 33.8 +/- 8.9 cm H2O; p < .0001) than historical controls.
Conclusion:
Adoption of the ARDS Network protocol for routine ventilator management of acute lung injury/acute respiratory distress syndrome patients was associated with a lower mortality compared with recent historical controls.