Mechanical ventilation (MV) with low tidal volumes (Vt: 8-6 cc/kg of IBW) has become a standard of care for patients with ARDS since mid-2000 (NEJM 2000, 342: 1301). To analyze MV setting’s habits for ARDS patients by Quebec ICU physicians, before and after the ARDS network report.
i) files of 71 ARDS patients from 5 Quebec ICUs studied from January 2000 to March 2002, ii) 2 groups arbitrarily defined to compare the period up to 6 months (i.e November 2000) following the ARDS network report, with the period after this landmark.Outcomes primary: the change of Vt over-time between the groups, secondary: mortality, number of days without organ failure, PEEP level, respiratory rate, PaCO2 .
21/71 patients were enrolled before the landmark and 50/71 after the landmark. Vt normalized to real or IBWs were reduced after Nov 2000 (7.8 +/- 0.2 vs 6.8 +/- 0.1 p<0.0001 and 9.3 +/- 0.2 vs 8.1 +/- 0.1 p<0.0001 respectively). There was no significant difference of mortality between the two groups (48% vs 36%, NS). PEEP (10.6 +/- 0.4 vs 13.9 +/- 0.2 p=0.02), respiratory rate (20 +/- 1.2 vs 29 +/- 0.6 p<0.0001), PaCO2 (47 +/- 1.4 vs 50 +/- 0.7 p=0.02) significantly changed. A trend towards higher number of days without organ dysfunction was found after November 2000 (all organs: 14.8 vs 20.5; p=0.08, renal: 19.5 vs 24.4; p=0.06, cardiovascular: 15.4 vs 22.4; p=0.07, hepatic 18.8 vs 22.4, p=0.2, coagulation; 18.4 vs 24.1; p=0.07).
Knowledge translation regarding on ventilation setting of ARDS patients has moved nearer standard practice in Quebec ICUs after the 2000 ARDS Net release. Morbidity was affected in this small cohort of patients.
Standard practice regarding on mechanical ventilation of ARDS patients has changed with time following the ARDS Net release, with trends toward lower secondary organ dysfunction rate.
Yannick POULIN, None.