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Published ahead of print on February 5, 2003, doi:10.1164/rccm.200205-478OC

Am. J. Respir. Crit. Care Med., Volume 167, Number 10, May 2003, 1304-1309

A more recent version of this article appeared on May 15, 2003
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Submitted on May 28, 2002
Accepted on January 31, 2003

Impact of randomized trial results on acute lung injury ventilator therapy in teaching hospitals

Craig R Weinert1*, Cynthia R Gross1, and William A Marinelli2

1 Medicine, University of Minnesota, Minneapolis, MN, USA, 2 Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Medicine, University of Minnesota, Minneapolis, MN, USA

* To whom correspondence should be addressed. E-mail: weine006{at}umn.edu.

Reducing tidal volumes administered to patients with acute lung injury is the only intervention reported to decrease mortality of this life-threatening condition. While many beneficial medical advances are slowly brought into practice, clinicians in teaching hospitals are often assumed to be early adopters of new medical advances. Our objective was to examine trends in the ventilatory prescription for 398 acute lung injury patients treated in three teaching hospitals from 1994 to 2001. There was no change in tidal volumes until mid-to-late 1998 when volumes started to slowly decline at the rate of 48.0 (95% CI: 21.0-74.4) ml/year. In the two years after the results were released from a large trial that demonstrated the superiority of 6 ml/kg tidal volume therapy over 12 ml/kg, clinicians prescribed tidal volumes of 651 ± 128 ml or 10.1 ± 1.9 ml/kg. Tidal volumes after intubation were minimally reduced over the subsequent two days of mechanical ventilation (mean reduction = 33 ml). Hospital category, male gender and disease onset before May 1999 were associated with higher tidal volumes whereas lung injury severity was inversely associated. We conclude that clinicians practicing at these teaching hospitals have not rapidly adopted low tidal volume ventilation that may reduce mortality.
Key words: Respiratory Distress Syndrome, Adult Respiration, artificial Physician's Practice patterns




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