1192: Lung-Protective Ventilation in the Emergency Department: Does an Ed-Based Icu Make a Difference?

Abstract

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: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. CONCLUSIONS: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.