Outcome issues of mechanical ventilator settings in acute respiratory distress syndrome patients from Québec ICUs after the 2000 Acute Respiratory Distress Syndrome Network trial

Abstract

Objective. To undertake a retrospective assessment of a knowledge translation of how a low tidal volume setting has affected the overall outcome of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) patients in Québec ICUs. Material and methods. This was a study of case files from five Québec ICUs, separated into two groups: those from before and after November 2000 (i.e. 6 months after the publication of the first ARDS Network trial). The primary outcome was changes in tidal volume. Secondary outcomes comprised mortality, number of days without organ dysfunction/failure, positive end-expiratory pressure (PEEP) level, respiratory rate and partial pressure of CO₂ (PaCO₂). Results. Of 105 patients, 55 were studied before and 50 after the landmark trial. Compared to the situation before November 2000: (i) tidal volume (normalized to predicted ideal body weight) fell; (ii) PEEP, respiratory rate and PaCO₂ rose; and (iii) in-hospital mortality decreased and days without organ failure increased after November 2000. Conclusions. The knowledge translation of ventilation settings for ALI/ARDS patients has moved closer to standard practice in Québec ICUs following the publication of the ARDS Network trial. This may have affected mortality and morbidity.

• Acute respiratory distress syndrome
• mechanical ventilation
• multiple organ failure
• outcome