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

J Crit Care. 1999 Mar;14(1):1-6. doi: 10.1016/s0883-9441(99)90001-1.


Purpose: The purpose of this study was to develop, implement, and evaluate a practice guideline using ketoconazole for the prevention of the adult respiratory distress syndrome (ARDS) in critically ill patients.

Materials and methods: In hospital A (study hospital), we developed a guideline for ketoconazole prophylaxis in patients at high risk of ARDS using evidence from two randomized trials. We prospectively implemented the guideline using intensive care unit (ICU) teaching sessions, in-services, informational posters, and patient-specific individual audit and feedback. ICU caregivers in hospital B (concurrent control hospital) did not participate in the guideline development or implementation and were unaware of the conduct of the study.

Results: Patients at risk of ARDS were similar in hospitals A and B. Implementation of the guideline was associated with a significantly higher use of ketoconazole use for ARDS prevention (P < .0001) and a significantly lower rate of ARDS (P < .05) in hospital A compared with hospital B. Mortality, duration of ventilation, and ICU stay were similar.

Conclusion: Development and implementation of a prophylactic ketoconazole practice guideline for ICU patients at high risk of ARDS was associated with a higher prescription of ketoconazole and a lower rate of ARDS in the study hospital than in the control hospital.

MeSH terms

  • Critical Care / standards*
  • Enzyme Inhibitors / therapeutic use*
  • Female
  • Humans
  • Intensive Care Units / standards*
  • Ketoconazole / therapeutic use*
  • Length of Stay
  • Male
  • Middle Aged
  • Ontario
  • Practice Guidelines as Topic*
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / prevention & control*
  • Surveys and Questionnaires
  • Thromboxane-A Synthase / antagonists & inhibitors*


  • Enzyme Inhibitors
  • Thromboxane-A Synthase
  • Ketoconazole