title: Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial.
abstract: OBJECTIVE
  We evaluated the efficacy of an emergency department (ED)-based lung-protective mechanical ventilation protocol for the prevention of pulmonary complications.
  
  
  METHODS
  This was a quasi-experimental, before-after study that consisted of a preintervention period, a run-in period of approximately 6 months, and a prospective intervention period. The intervention was a multifaceted ED-based mechanical ventilator protocol targeting lung-protective tidal volume, appropriate setting of positive end-expiratory pressure, rapid oxygen weaning, and head-of-bed elevation. A propensity score-matched analysis was used to evaluate the primary outcome, which was the composite incidence of acute respiratory distress syndrome and ventilator-associated conditions.
  
  
  RESULTS
  A total of 1,192 patients in the preintervention group and 513 patients in the intervention group were included. Lung-protective ventilation increased by 48.4% in the intervention group. In the propensity score-matched analysis (n=490 in each group), the primary outcome occurred in 71 patients (14.5%) in the preintervention group compared with 36 patients (7.4%) in the intervention group (adjusted odds ratio 0.47; 95% confidence interval [CI] 0.31 to 0.71). There was an increase in ventilator-free days (mean difference 3.7; 95% CI 2.3 to 5.1), ICU-free days (mean difference 2.4; 95% CI 1.0 to 3.7), and hospital-free days (mean difference 2.4; 95% CI 1.2 to 3.6) associated with the intervention. The mortality rate was 34.1% in the preintervention group and 19.6% in the intervention group (adjusted odds ratio 0.47; 95% CI 0.35 to 0.63).
  
  
  CONCLUSIONS
  Implementing a mechanical ventilator protocol in the ED is feasible and is associated with significant improvements in the delivery of safe mechanical ventilation and clinical outcome.
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: fullerb@wustl.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.affiliation: School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Ferguson
authors.affiliation: Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Drewry
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Christopher
authors.initials: C
authors.lastname: Palmer
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Wessman
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Enyo
authors.initials: E
authors.lastname: Ablordeppey
authors.affiliation: Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Jacob
authors.initials: J
authors.lastname: Keeperman
authors.affiliation: Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stephens
authors.affiliation: Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Cristopher C
authors.initials: CC
authors.lastname: Briscoe
authors.affiliation: School of Public Health and Social Justice, Saint Louis University, St. Louis, MO.
authors.forename: Angelina A
authors.initials: AA
authors.lastname: Kolomiets
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hotchkiss
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D004636:Emergency Service, Hospital; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D056888:Patient Positioning; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D056152:Respiratory Rate; D013990:Tidal Volume