Nathan Haas, MD
Assistant Professor of Emergency Medicine
n/a, United States
Disclosure information not submitted.
Chiu-Mei Chen, MS, MA
Business Intelligence Analyst Senior
University of Michigan, United States
Disclosure information not submitted.
James Cranford, PhD
Associate Research Scientist
Hurley Medical Center, United States
Disclosure information not submitted.
Joseph Hamera, MD
ECLS Fellow
University of Maryland, United States
Disclosure information not submitted.
Renee Havey, MS, RN, CCRN, ACNS-BC, CEN
Clinical Nurse Specialist
University of Michigan, United States
Disclosure information not submitted.
Ryan Tsuchida, MD
Assistant Professor of Emergency Medicine
University of Wisconsin, United States
Disclosure information not submitted.
Benjamin Bassin, MD
Director of Operations, Emergency Critical Care Center
University of Michigan
Ann Arbor, Michigan, United States
Disclosure information not submitted.
Henrique Alencastro Puls, MD
House-Officer IV
University of Michigan
Ann Arbor, MI
Disclosure information not submitted.
Title: Lung Protective Ventilation in the Emergency Department: Does an ED-based ICU Make a Difference?
Introduction: 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, however, adherence to LPV among ED patients is low. The impact of an ED-based Intensive Care Unit (ED-ICU) on LPV adherence is not known.
Methods: This single-center retrospective cohort study analyzed rates of adherence to a multi-faceted 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 compliant with best-evidence recommendations. The primary outcome was adherence to the LPV strategy at time of ED departure.
Results & Conclusions: A total of 561 ED visits were included in the analysis, of which 60.0% received some portion of their care in an ED-ICU. Adherence to the LPV strategy was statistically significantly higher in the ED-ICU cohort compared to the pre ED-ICU cohort (65.8% vs 41.4%, p < .001) and non ED-ICU cohort (65.8% vs 43.1%, p < .001). Among the ED-ICU cohort, 92.8% of patients received low tidal volume ventilation. Care in an 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 associated with an ED-ICU.