title: Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls.
abstract: OBJECTIVE
  To assess the impact of implementing a low tidal volume ventilation strategy on hospital mortality for patients with acute lung injury or acute respiratory distress syndrome.
  
  
  METHODS
  Retrospective, uncontrolled study.
  
  
  METHODS
  Adult medical-surgical and trauma intensive care units at a major inner city, university-affiliated hospital.
  
  
  METHODS
  A total of 292 patients with acute lung injury or acute respiratory distress syndrome.
  
  
  METHODS
  Between the years 2000 and 2003, 200 prospectively identified patients with acute lung injury/acute respiratory distress syndrome were managed by the ARDS Network low tidal volume protocol. A historical control group of 92 acute respiratory distress syndrome patients managed by routine practice from 1998 to 1999 was used for comparison.
  
  
  RESULTS
  Patients managed with the ARDS Network protocol had a lower hospital mortality compared with historical controls (32% vs. 51%, respectively; p = .004). Multivariate logistic regression estimated an odds ratio of 0.32 (95% CI, 0.17-0.59; p = .0003) for mortality risk with use of the ARDS Network protocol. Protocol-managed patients had a lower tidal volume (6.2 +/- 1.1 vs. 9.8 +/- 1.5 mL/kg; p < .0001) and plateau pressure (27.5 +/- 6.4 vs. 33.8 +/- 8.9 cm H2O; p < .0001) than historical controls.
  
  
  CONCLUSIONS
  Adoption of the ARDS Network protocol for routine ventilator management of acute lung injury/acute respiratory distress syndrome patients was associated with a lower mortality compared with recent historical controls.
authors.affiliation: Department of Anesthesia, University of California, San Francisco at San Francisco General Hospital, California, USA.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Kallet
authors.forename: Robert M
authors.initials: RM
authors.lastname: Jasmer
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Pittet
authors.forename: Julin F
authors.initials: JF
authors.lastname: Tang
authors.forename: Andre R
authors.initials: AR
authors.lastname: Campbell
authors.forename: Rochelle
authors.initials: R
authors.lastname: Dicker
authors.forename: Claude
authors.initials: C
authors.lastname: Hemphill
authors.forename: John M
authors.initials: JM
authors.lastname: Luce
mesh_terms: D018806:APACHE; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000145:classification / Q000401:mortality / Q000628:therapy*