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

Brian M. Fuller, Ian T. Ferguson, Nicholas M. Mohr, Anne M. Drewry, Christopher Palmer, Brian T. Wessman, Enyo Ablordeppey, Jacob Keeperman, Robert J. Stephens, Cristopher C. Briscoe, Angelina A. Kolomiets, Richard S. Hotchkiss, Marin H. Kollef

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

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.

Original languageEnglish
Pages (from-to)406-418.e4
JournalAnnals of emergency medicine
Volume70
Issue number3
DOIs
StatePublished - Sep 2017

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