Background: Low tidal volume ventilation reduces mortality in patients with acute lung injury (ALI) and may reduce the risk of ALI in ventilated patients. A previous audit of our ventilation practices showed poor adherence to low tidal volume ventilation, and we subsequently introduced written ventilation guidelines and an education program to change practice.
Objectives: To determine if adherence to low tidal volume ventilation (defined as mandatory tidal volumes of =?6.5 mL/ kg predicted body weight [PBW]) in ventilated patients was improved with a written guideline and staff education.
Design And Setting: Retrospective analysis of recorded mandatory ventilator settings from the clinical information system of a tertiary referral intensive care unit from 1 January 2012 to 31 December 2015, involving analysis of mandatory ventilator settings in relation to PBW to determine adherence to guidelines, and interrupted time-series analysis to assess the impact of education.
Main Outcome Measure: Adherence to low tidal volume ventilation.
Results: The mean tidal volume for the cohort was 7.4 mL/ kg (SD, 1.3 mL/kg) PBW, and 760 patients (26.9%) received an average tidal volume during mandatory ventilation of ≤6.5 mL/kg PBW. Interrupted time-series analysis showed improved adherence after education, with an increase in adherence of 29.4% (95% CI, 19.3%-39.5%) from baseline. Multivariate logistic analysis found height, weight and staff education, but not sex, were associated with adherence to low tidal volume ventilation.
Conclusion: Written protocols and education can influence clinician behaviour, with substantial improvements in adherence to low tidal volume ventilation. Efforts to improve adherence through ward-based education appear warranted and necessary. Adherence was strongly associated with patient height, which suggested that adherence was partly the result of chance rather than design.
Download full-text PDF |
Source |
|---|
Publication Analysis
Top Keywords
Similar Publications
A quality assurance protocol for reliable and reproducible multi-TI arterial spin labeling perfusion imaging in rat livers.
MAGMA
January 2025
Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
Objective: To establish an arterial spin labeling (ASL) protocol for rat livers that improves data reliability and reproducibility for perfusion quantification.
Methods: This study used respiratory-gated, single-slice, FAIR-based ASL imaging with multiple inversion times (TI) in rat livers. Quality assurance measures included: (1) introduction of mechanical ventilation to ensure consistent respiratory cycles by controlling the respiratory rate (45 bpm), tidal volume (10 ml/kg), and inspiration: expiration ratio (I:E ratio, 1:2), (2) optimization of the trigger window for consistent trigger points, and (3) use of fit residual map and coefficient of variance as metrics to assess data quality.
Effects of pulmonary rehabilitation on respiratory function in mechanically ventilated patients: a systematic review and meta-analysis.
BMC Pulm Med
January 2025
The First Affiliated Hospital of Sun Yat-Sen University, Guangdong, 510080, China.
Aim: The aim of this systematic review and meta-analysis was to explore the effects of different pulmonary rehabilitation on respiratory function in mechanically ventilated patients and to determine the optimal type of intervention.
Method: A comprehensive search was conducted using PubMed, Embase, Web of Science, Joanna Briggs Institute(JBI), and the Cochrane Library from their inception until September 16th, 2024. The search targeted randomized controlled trials (RCTs) comparing pulmonary rehabilitation or usual care, for improving respiratory function in mechanically ventilated patients.
Invasive mechanical ventilation strategies, adjuvants treatments and adverse events among ICU patients with COVID-19 in Denmark.
Acta Anaesthesiol Scand
February 2025
Department of Anesthesiology and Intensive Care, Kolding Hospital, Denmark.
Aim: To describe the use of invasive mechanical ventilation core strategies, adjuvant treatments and the occurrence of barotrauma and prolonged ventilation in ICU patients with COVID-19 in Denmark, retrospectively.
Methods: All ICUs admitting COVID-19 patients in Denmark from 10 March 2020 to 2 April 2021 were invited to participate. All patients with COVID-19 who received invasive mechanical ventilation were included and data was retrospectively collected from electronic patient records.
Cerebrovascular regulation in patients with active tumors and an acute ischemic stroke: a retrospective analysis.
Front Physiol
December 2024
Department of Radiology and Nuclear Medicine, Section Diagnostic and Invasive Neuroradiology, Lucerne Cantonal Hospital, Lucerne, Switzerland.
Introduction: Ischemic stroke in patients with a systemic tumor disease or cancer not in remission (active tumors) is less well understood. Some aspects of such paraneoplastic strokes remind on a generalized cerebrovascular disorder. We hypothesized that cerebrovascular regulation in active tumor patients with a stroke is different from other patients with stroke who have no active tumor disease.
View Article and Find Full Text PDFReview of Point-of-Care Diaphragmatic Ultrasound in Emergency Medicine: Background, Techniques, Achieving Competency, Research, and Recommendations.
Pediatr Emerg Care
January 2025
Chief of Division of Pediatric Pulmonary Medicine, Franciscan Children's Hospital, Boston MA.
The diaphragm is the major muscle of inspiration accounting for approximately 70% of the inspired tidal volume. Point-of-care diaphragmatic ultrasound offers the ability to quantitatively assess diaphragmatic function, perform serial evaluations over time, and visualize structures above and below the diaphragm. Although interest in point-of-care ultrasound (POCUS) of the diaphragm is developing in the emergency medicine, assessment of the diaphragm and its function is not recognized as a core application by national organizations or expert guidelines.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!