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Cecilia Loudet Gabriela Vidal Vinicius Torsani Julio Fiore Jr. Fernando Queiroga Arturo Huerta

MECOR COURSE LEVEL 1. “Use of lung-protective ventilation strategy in acute respiratory distress syndrome (ARDS) in teaching and non-teaching hospitals: a pilot study”. Cecilia Loudet Gabriela Vidal Vinicius Torsani Julio Fiore Jr. Fernando Queiroga Arturo Huerta

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Cecilia Loudet Gabriela Vidal Vinicius Torsani Julio Fiore Jr. Fernando Queiroga Arturo Huerta

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  1. MECOR COURSE LEVEL 1 “Use of lung-protective ventilation strategy in acute respiratory distress syndrome (ARDS) in teaching and non-teaching hospitals: a pilot study” Cecilia Loudet Gabriela Vidal Vinicius Torsani Julio Fiore Jr. Fernando Queiroga Arturo Huerta Coordinators: Elisa Estenssoro Peter Wagner

  2. 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.

  3. 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.

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

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

  6. Study design and time frame • Multinational • Multicenter • Cross sectional study • Six-month duration

  7. Selection criteria • Inclusion criteria Patients in mechanical ventilation who meet the criteria for ARDS (AECC) • Exclusion criteria • Do-not-resuscitate orders • Contraindications for lung-protective ventilation strategy

  8. 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.

  9. Variables • Outcome variables - Use of lung-protective ventilatory strategy in patients with ARDS defined 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

  10. Variables • Outcome variables - Use of lung-protective ventilatory strategy in patients with ARDS defined 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

  11. Variables • Outcome variables - Use of lung-protective ventilatory strategy in patients with ARDS defined 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

  12. Variables • Outcome variables - Use of lung-protective ventilatory strategy in patients with ARDS defined 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

  13. 2 x 2 table OUTCOME: PROTECTIVE VENTILATION + - + ? ? EXPOSURE: TEACHING HOSPITAL ? ? -

  14. Procedures • 18 ICUs will be sampled: (6 per country) • 2 in teaching hospitals • 4 in non-teaching hospitals

  15. 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

  16. 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

  17. 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

  18. Take-home messages: • CONCEPTOS CLAROS!

  19. Take-home messages: • SENTIDO DE ÉXITO!

  20. Take-home messages: • “ESTADISSSTICA”!

  21. Take-home messages: • ¿How rare?...

  22. “p” VALUE RARE!!!!

  23. THANK YOU MECOR!!!

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

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