Development, implementation, and evaluation of a ketoconazole practice guideline for ARDS prophylaxis

Purpose: The purpose of this study was to develop, implement, and evaluate a practice guideline using ketoconazole for the prevention of the adult res piratory distress syndrome (ARDS) in critically ill patients. Materials and Methods: In hospital A (study hospital), we developed a guide line for ketoconazole prophylaxis in patients at high risk of ARDS using ev idence from two randomized trials. We prospectively implemented the guideli ne using intensive care unit (ICU) teaching sessions, in-services, informat ional posters, and patient-specific individual audit and feedback. ICU care givers in hospital B (concurrent control hospital) did not participate in t he guideline development or implementation and were unaware of the conduct of the study. Results: Patients at risk of ARDS were similar in hospitals A and B, Implem entation of the guideline was associated with a significantly higher use of ketoconazole use for ARDS prevention (P < .0001) and a significantly lower rate of ARDS (P < .05) in hospital A compared with hospital B, Mortality, duration of ventilation, and ICU stay were similar. Conclusion: Development and implementation of a prophylactic ketoconazole p ractice guideline for ICU patients at high risk of ARDS was associated with a higher prescription of ketoconazole and a lower rate of ARDS in the stud y hospital than in the control hospital. Copyright (C) 1999 by W.B. Saunder s Company.