Clinical implementation of the ARDS network protocol is associated with reduced hospital mortality compared with historical controls

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. Design., Retrospective, uncontrolled study. Setting. Adult medical-surgical and trauma intensive care units at a major inner city, university-affiliated hospital. Patients. A total of 292 patients with acute lung injury or acute respiratory distress syndrome. Interventions: 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. Measurements and Main 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. Conclusion: 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.