Performance of Computerized Protocols for the Management of Arterial Oxygenation in an Intensive Care Unit
Adult respiratory distress syndrome (ARDS) is a form of respiratory failure characterized clinically by severe hypoxemia, diffuse infiltrates on chest radiograph, and decreased lung compliance. In its most severe form it has a survival of about 10%. In 1984, Gattinoni et al. reported a 77% survival in this subset of ARDS patients using a new form of therapy . The new therapy included pressure controlled inverse ratio ventilation (PCIRV) and low frequency positive pressure ventilation with extracorporeal CO2 removal (ECC02R). Its goal was to reduce the peak and average pressures applied to the lungs by mechanical ventilators. The extraordinary survival reported with this new therapy and the fact that it was the result of an uncontrolled trial led to the design of a prospective randomized controlled clinical trial comparing PCIRV and ECC02R with traditional positive pressure ventilatory support. The trial was executed at the LDS Hospital from 1987 to 1991. During the design phase of this trial it became obvious that the novelty of extracorporeal support could cause increased interest among the clinical staff, resulting in a difference in the intensity of care between patients receiving ECC02R and patients receiving traditional ventilatory care. This created the possibility that differences in the intensity of therapy would bias the outcome of the study. To assure equivalency of care in both the control and new therapy limbs of the study, protocols were developed to control the management of arterial oxygenation in all study patients [2-4].
KeywordsClinical Staff Adult Respiratory Distress Syndrome Computerize Protocol Total Instruction Therapy Instruction
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