Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial

Study 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 [Cl] 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% Cl 1.0 to 3.7), and hospital-free days (mean difference 2.4; 95% Cl 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). Conclusion: 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.