“Use of lung-protective ventilation strategy in acute respiratory distress syndrome (ARDS) in teaching and non-teaching hospitals: a pilot study”

Cecilia LoudetGabriela VidalVinicius TorsaniJulio Fiore Jr.Fernando QueirogaArturo Huerta

Coordinators: Elisa Estenssoro Peter Wagner

MECOR COURSELEVEL 1

Introduction• Research question

– Is lung-protective ventilation strategy in ARDS patients more commonly used in teaching hospitals than in non-teaching hospitals?

• Hypothesis– Lung-protective ventilation strategy in

patients with ARDS is more frequently used in teaching than in non-teaching hospitals.

Significance & Background • Many studies suggest that evidence-

based practice is not being transmitted to clinical practice.

• Lung-protective ventilation strategy in patients with ARDS is strongly recommended in the medical literature, but not frequently applied.

• We propose a pilot study since there are no data in Latin America dealing with these topics.

Young M. Crit Care Med. 32(6):1260-1265.

The Acute Respiratory Distress Syndrome Network N Engl J Med 2000; 342:1301-1308.

Study design and time frame

•Multinational

•Multicenter

•Cross sectional study

•Six-month duration

Selection criteria

• Inclusion criteriaPatients in mechanical ventilation who meet the criteria for ARDS (AECC)

• Exclusion criteria• Do-not-resuscitate orders• Contraindications for lung-

protective ventilation strategy

Variables

• Exposure variables

- Teaching hospital: with internal medicine or critical care residents working in the ICU.

- Non-teaching hospital: without internal medicine or critical care residents working in the ICU.

• Outcome variables

- Use of lung-protective ventilatory strategy in patients with ARDSdefined as:

» Tidal volume less than 6.5 ml/kg OR

» Tidal volume less than 6.5 ml/kg and plateau pressure less than 30 mmHg OR

» Tidal volume less than 8 ml/kg and plateau pressure less than 30 mmHg

Variables

• Outcome variables

- Use of lung-protective ventilatory strategy in patients with ARDSdefined as:

» Tidal volume less than 6.5 ml/kg OR

» Tidal volume less than 6.5 ml/kg and plateau pressure less than 30 mmHg OR

» Tidal volume less than 8 ml/kg and plateau pressure less than 30 mmHg

Variables

• Outcome variables

- Use of lung-protective ventilatory strategy in patients with ARDSdefined as:

» Tidal volume less than 6.5 ml/kg OR

» Tidal volume less than 6.5 ml/kg and plateau pressure less than 30 mmHg OR

» Tidal volume less than 8 ml/kg and plateau pressure less than 30 mmHg

Variables

• Outcome variables

- Use of lung-protective ventilatory strategy in patients with ARDSdefined as:

» Tidal volume less than 6.5 ml/kg OR

» Tidal volume less than 6.5 ml/kg and plateau pressure less than 30 mmHg OR

» Tidal volume less than 8 ml/kg and plateau pressure less than 30 mmHg

Variables

2 x 2 table

+ -

+

-

OUTCOME:

PROTECTIVE VENTILATION

EXPOSURE:

TEACHING HOSPITAL

?

?

?

?

Procedures

•18 ICUs will be sampled: (6 per country)

–2 in teaching hospitals–4 in non-teaching hospitals

Procedures

• During 4 consecutive days, at 10 am., investigators will record in a pre-impressed sheet of paper:

•Patient demographics•Ventilator settings•Blood gases•Blood chemistry

Statistics

• Sample size - Will be calculated after this pilot, which will allow us to have an effect size

• Analysis:- Chi2 test- “p” value 0,05- If data of the pilot study are consistent

(small variability) = the definitive study will be a one day cross-sectional study

Budget estimation

• Computer: US$ 1.000 x 3• Paper: US$ 50• Printer: US$ 150• Tonner: US$ 50• Researchers (total): US$ 2160

(US$ 30/day)• Transport: US$ 720• Total: US$ 6130

Take-home messages:

• CONCEPTOS CLAROS!

Take-home messages:

• SENTIDO DE ÉXITO!

Take-home messages:

• “ESTADISSSTICA”!

Take-home messages:

• ¿How rare?...

“p”

VALUE

RARE!!!!

THANK YOU MECOR!!!

Acknowledgements

• Gordon Rubenfeld • Señor Bill• Cindy Rand• Steve McCurdy• Peter Wagner• Elisa Estenssoro• All the faculty of MECOR