Implementation of lung protective ventilation order to improve adherence to low tidal volume ventilation: A RE-AIM evaluation.

Autor: Short B; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America. Electronic address: bs2886@cumc.columbia.edu., Serra A; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America., Tariq A; The Value Institute at NewYork-Presbyterian Hospital, New York, NY, United States of America., Moitra V; Department of Anesthesia, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America., Brodie D; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America., Patel S; The New York State Psychiatric Institute, Research Foundation for Mental Hygiene, New York, NY, United States of America; Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, United States of America., Baldwin MR; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America., Yip NH; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2021 Jun; Vol. 63, pp. 167-174. Date of Electronic Publication: 2020 Sep 20.
DOI: 10.1016/j.jcrc.2020.09.013
Abstrakt: Purpose: Lung protective ventilation (LPV), defined as a tidal volume (Vt) ≤8 cc/kg of predicted body weight, reduces ventilator-induced lung injury but is applied inconsistently.
Materials and Methods: We conducted a prospective, quasi-experimental, cohort study of adults mechanically ventilated admitted to intensive care units (ICU) in the year before, year after, and second year after implementation of an electronic medical record based LPV order, and a cross-sectional qualitative study of ICU providers regarding their perceptions of the order. We applied the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the implementation.
Results: There were 1405, 1424, and 1342 in the control, adoption, and maintenance cohorts, representing 95% of mechanically ventilated adult ICU patients. The overall prevalence of LPV increased from 65% to 73% (p < 0.001, adjusted-OR for LPV adherence: 1.9, 95% CI 1.5-2.3), but LPV adherence in women was approximately 30% worse than in men (women: 44% to 56% [p < 0.001],men: 79% to 86% [p < 0.001]). ICU providers noted difficulty obtaining an accurate height measurement and mistrust of the Vt calculation as barriers to implementation. LPV adherence increased further in the second year post implementation.
Conclusion: We designed and implemented an LPV order that sustainably improved LPV adherence across diverse ICUs.
Competing Interests: Declaration of Competing Interest There are no conflicts of interest or competing interest regarding this manuscript.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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