Initiation of a Lung Protective Ventilation Strategy in the Emergency Department: Does an Emergency Department-Based ICU Make a Difference?

Autor:	Harvey CE; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI., Haas NL; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.; Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI., Chen CM; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI., Cranford JA; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI., Hamera JA; Department of Emergency Medicine, University of Maryland, Baltimore, MD., Havey RA; Adult Emergency Services, Michigan Medicine, Ann Arbor, MI., Tsuchida RE; Department of Emergency Medicine, University of Wisconsin, Madison, WI., Bassin BS; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.; Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor, MI.; Weil Institute for Critical Care Research and Innovation, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2022 Feb 08; Vol. 4 (2), pp. e0632. Date of Electronic Publication: 2022 Feb 08 (Print Publication: 2022).
DOI:	10.1097/CCE.0000000000000632
Abstrakt:	Background: Lung protective ventilation (LPV) is a key component in the management of acute respiratory distress syndrome and other acute respiratory pathology. Initiation of LPV in the emergency department (ED) is associated with improved patient-centered and system outcomes, but adherence to LPV among ED patients is low. The impact of an ED-based ICU (ED-ICU) on LPV adherence is not known. Methods: This single-center, retrospective, cohort study analyzed rates of adherence to a multifaceted LPV strategy pre- and post-implementation of an ED-ICU. LPV strategy components included low tidal volume ventilation, avoidance of severe hyperoxia and high plateau pressures, and positive end-expiratory pressure settings in alignment with best-evidence recommendations. The primary outcome was adherence to the LPV strategy at time of ED departure. Results and Conclusions: A total of 561 ED visits were included in the analysis, of which 60.0% received some portion of their emergency care in the ED-ICU. Adherence to the LPV strategy was statistically significantly higher in the ED-ICU cohort compared with the pre-ED-ICU cohort (65.8% vs 41.4%; p < 0.001) and non-ED-ICU cohort (65.8% vs 43.1%; p < 0.001). Among the ED-ICU cohort, 92.8% of patients received low tidal volume ventilation. Care in the ED-ICU was also associated with shorter ICU and hospital length of stay. These findings suggest improved patient and resource utilization outcomes for mechanically ventilated ED patients receiving care in an ED-ICU. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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