Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls

Crit Care Med. 2005 May;33(5):925-9. doi: 10.1097/01.ccm.0000162382.59289.9c.

Abstract

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.

Publication types

  • Comparative Study

MeSH terms

  • APACHE
  • Adult
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Positive-Pressure Respiration
  • Respiration, Artificial
  • Respiratory Distress Syndrome, Adult / classification
  • Respiratory Distress Syndrome, Adult / mortality
  • Respiratory Distress Syndrome, Adult / therapy*