Studies suggest variable adoption of evidence-based practice guidelines. The authors hypothesized that compliance with guidelines for patients requiring mechanical ventilation would vary among academic medical centers and that this variation might be associated with survival. A total of 1463 intensive care unit cases receiving continuous mechanical ventilation for >96 hours were reviewed. The variation in mortality based on compliance with 6 evidence-based practices was determined, and the effect of each intervention was estimated using a logistic regression model. Compliance varied widely across the participating centers. A strong association with survival was seen for 2 of the 6 practices: sedation management and glycemic control (odds ratios for death of 0.30 and 0.46, respectively, each P < .01). Spontaneous breathing trials, deep venous thrombosis prophylaxis, semi-recumbent positioning, and stress ulcer prophylaxis were not associated with survival in the model. More consistent adoption of these practices represents an opportunity for academic medical centers and was associated with enhanced survival.