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Hungarian sites of the multinational VALID study are responsive to training measures advocating the ARDS Network ventilation protocol

Introduction

Adherence to the ARDS Network low-stretch ventilation protocol [1] is recommended as standard of care in the VALID study, a randomised double-blind mortality study of rSP-C surfactant (Venticute®) in intubated and mechanically ventilated patients with severe respiratory failure due to pneumonia or aspiration. Ten Hungarian study sites have recruited about 9% of patients in the VALID study to date.

Methods

The VALID study is conducted in more than 140 medical centers in 23 countries. Adherence to ARDS Network ventilation standards was assessed after 200 patients were randomised. Subsequently, an intensified training program to promote low-stretch ventilation was conducted during site visits and investigator meetings, through letters and emails, by distributing training material, and by discussing ventilation settings prior to enrolment of individual patients. In Hungary, data are available from 24 patients enrolled prior to implementation of training measures and from 45 patients enrolled thereafter. Tidal volumes (VT) and peak inspiratory pressures (PIP) at baseline were assessed.

Results

In Hungary, the median VT at baseline decreased from 8.2 ml/kg predicted body weight (PBW) prior to initiation of intensified training measures to 7.3 ml/kg PBW thereafter (P < 0.001, Wilcoxon, two-sided). Concurrently, the overall study median VT decreased from 7.8 ml/kg PBW (Patient 1 to Patient 200) to 7.0 ml/kg PBW (Patient 201 to Patient 776). The two Hungarian sites with the highest enrolment decreased the median VT from 8.2 to 7.5 ml/kg PBW and from 9.1 to 6.6 ml/kg PBW. The median PIP at baseline decreased from 30.8 to 29.0 cmH2O in Hungary and from 29.5 to 28.5 cmH2O in the VALID study overall.

Conclusion

In response to training measures, Hungarian investigators participating in a multinational multicenter intensive care trial of lung surfactant in ventilated patients have decreased VT and PIP, thereby improving adherence to the global standards of the ARDS Network ventilation protocol.

References

  1. 1.

    The ARDS Network: N Engl J Med. 2000, 342: 1301-1308. 10.1056/NEJM200005043421801

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Madách, K., Marjanek, Z., Ortutay, A. et al. Hungarian sites of the multinational VALID study are responsive to training measures advocating the ARDS Network ventilation protocol. Crit Care 12, P284 (2008). https://doi.org/10.1186/cc6505

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Keywords

  • Valid Study
  • Inspiratory Pressure
  • Ventilation Setting
  • Peak Inspiratory Pressure
  • Lung Surfactant