Development, implementation, and evaluation of a ketoconazole practice guideline for ARDS prophylaxis.
OBJECTIVE
The purpose of this study was to develop, implement, and evaluate a practice guideline using ketoconazole for the prevention of the adult respiratory distress syndrome (ARDS) in critically ill patients.


METHODS
In hospital A (study hospital), we developed a guideline for ketoconazole prophylaxis in patients at high risk of ARDS using evidence from two randomized trials. We prospectively implemented the guideline using intensive care unit (ICU) teaching sessions, in-services, informational posters, and patient-specific individual audit and feedback. ICU caregivers in hospital B (concurrent control hospital) did not participate in the guideline development or implementation and were unaware of the conduct of the study.


RESULTS
Patients at risk of ARDS were similar in hospitals A and B. Implementation of the guideline was associated with a significantly higher use of ketoconazole use for ARDS prevention (P < .0001) and a significantly lower rate of ARDS (P < .05) in hospital A compared with hospital B. Mortality, duration of ventilation, and ICU stay were similar.


CONCLUSIONS
Development and implementation of a prophylactic ketoconazole practice guideline for ICU patients at high risk of ARDS was associated with a higher prescription of ketoconazole and a lower rate of ARDS in the study hospital than in the control hospital.
Sinuff
T
T
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Cook
D J
DJ
Peterson
J C
JC
Fuller
H D
HD
D018806:APACHE; D003422:Critical Care / Q000592:standards*; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007654:Ketoconazole / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013930:Thromboxane-A Synthase / Q000037:antagonists & inhibitors*
D004791:Enzyme Inhibitors; D013930:Thromboxane-A Synthase; D007654:Ketoconazole