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Observational Study
. 2017 Sep;70(3):406-418.e4.
doi: 10.1016/j.annemergmed.2017.01.013. Epub 2017 Mar 2.

Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial

Brian M Fuller  1 , Ian T Ferguson  2 , Nicholas M Mohr  3 , Anne M Drewry  4 , Christopher Palmer  5 , Brian T Wessman  5 , Enyo Ablordeppey  5 , Jacob Keeperman  5 , Robert J Stephens  6 , Cristopher C Briscoe  6 , Angelina A Kolomiets  7 , Richard S Hotchkiss  4 , Marin H Kollef  8
Affiliations
Observational Study

Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial

Brian M Fuller et al. Ann Emerg Med. 2017 Sep.

Abstract

Study objective: We evaluated the efficacy of an emergency department (ED)-based lung-protective mechanical ventilation protocol for the prevention of pulmonary complications.

Methods: This was a quasi-experimental, before-after study that consisted of a preintervention period, a run-in period of approximately 6 months, and a prospective intervention period. The intervention was a multifaceted ED-based mechanical ventilator protocol targeting lung-protective tidal volume, appropriate setting of positive end-expiratory pressure, rapid oxygen weaning, and head-of-bed elevation. A propensity score-matched analysis was used to evaluate the primary outcome, which was the composite incidence of acute respiratory distress syndrome and ventilator-associated conditions.

Results: A total of 1,192 patients in the preintervention group and 513 patients in the intervention group were included. Lung-protective ventilation increased by 48.4% in the intervention group. In the propensity score-matched analysis (n=490 in each group), the primary outcome occurred in 71 patients (14.5%) in the preintervention group compared with 36 patients (7.4%) in the intervention group (adjusted odds ratio 0.47; 95% confidence interval [CI] 0.31 to 0.71). There was an increase in ventilator-free days (mean difference 3.7; 95% CI 2.3 to 5.1), ICU-free days (mean difference 2.4; 95% CI 1.0 to 3.7), and hospital-free days (mean difference 2.4; 95% CI 1.2 to 3.6) associated with the intervention. The mortality rate was 34.1% in the preintervention group and 19.6% in the intervention group (adjusted odds ratio 0.47; 95% CI 0.35 to 0.63).

Conclusion: Implementing a mechanical ventilator protocol in the ED is feasible and is associated with significant improvements in the delivery of safe mechanical ventilation and clinical outcome.

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Conflict of interest statement

Summary Conflict of Interest Statement: All authors declare that no conflicts of interest exist.

Figures

Figure 1
Figure 1
Emergency department ventilator protocol
Figure 2
Figure 2
Study flow diagram
Figure 3
Figure 3. Distribution of emergency department tidal volume
There was an increase in lung-protective ventilation in the ED associated with the intervention (47.8% to 96.2%). ED: emergency department; PBW: predicted body weight
See this image and copyright information in PMC

Comment in

References

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