Daniel J. Pallin, MD, MPH reviewing Fuller BM et al. Ann Emerg Med 2017 Mar 3.

An observational study provides indirect evidence in favor of initiating lung-protective ventilation in the emergency department.

We recently covered an article on an intervention for emergency department–initiated lung-protective ventilation that presented results for a subset of patients in a larger study (NEJM JW Emerg Med Mar 3 2017; [e-pub] and Crit Care Med 2017 Feb 2; [e-pub]). Now the researchers have reported results of the full study.

The intervention was a multifaceted educational program that reinforced the importance of low tidal volumes, appropriate positive end-expiratory pressure settings, oxygen weaning, and elevating the head of the bed. The researchers compared the combined occurrence of acute respiratory distress syndrome and “ventilator-associated conditions” (primary outcome) between 490 patients in the preintervention period and 490 in the postintervention period who were matched by propensity score.

The primary outcome was twice as common in the preintervention period (14.5% vs. 7.4%; adjusted odds ratio 0.47). The preintervention group also spent more time on a ventilator (mean difference, 3.7 days), in the intensive care unit (2.4 days), and in the hospital (2.4 days). Mortality was nearly twice as high in the preintervention group (34.1% vs. 19.6%; aOR, 0.47).

CITATION(S):

Fuller BM et al. Lung-protective ventilation initiated in the emergency department (LOV-ED): A quasi-experimental, before-after trial. Ann Emerg Med 2017 Mar 3; [e-pub]. 

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