Impact of Providing a Tape Measure on the Provision of Lung-protective Ventilation.

Autor:	Ives Tallman CM; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan Medical School, Department of Anesthesiology/Critical Care, Ann Arbor, Michigan., Harvey CE; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan Medical School, Division of Emergency Critical Care, Ann Arbor, Michigan., Laurinec SL; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan Medical School, Division of Emergency Critical Care, Ann Arbor, Michigan.; University of Michigan, Center for Integrative Research in Critical Care, Ann Arbor, Michigan., Melvin AC; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan Medical School, Division of Emergency Critical Care, Ann Arbor, Michigan., Fecteau KA; University of Michigan Medical School, Department of Respiratory Care, Ann Arbor, Michigan., Cranford JA; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan, Center for Integrative Research in Critical Care, Ann Arbor, Michigan., Haas NL; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan Medical School, Division of Emergency Critical Care, Ann Arbor, Michigan.; University of Michigan, Center for Integrative Research in Critical Care, Ann Arbor, Michigan., Bassin BS; University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.; University of Michigan Medical School, Division of Emergency Critical Care, Ann Arbor, Michigan.; University of Michigan, Center for Integrative Research in Critical Care, Ann Arbor, Michigan.
Jazyk:	angličtina
Zdroj:	The western journal of emergency medicine [West J Emerg Med] 2021 Jan 11; Vol. 22 (2), pp. 389-393. Date of Electronic Publication: 2021 Jan 11.
DOI:	10.5811/westjem.2020.10.49104
Abstrakt:	Introduction: Emergency department (ED) patients are frequently ventilated with excessively large tidal volumes for predicted body weight based on height, which has been linked to poorer patient outcomes. We hypothesized that supplying tape measures to respiratory therapists (RT) would improve measurement of actual patient height and adherence to a lung-protective ventilation strategy in an ED-intensive care unit (ICU) environment. Methods: On January 14, 2019, as part of a ventilator-associated pneumonia prevention bundle in our ED-based ICU, we began providing RTs with tape measures and created a best practice advisory reminding them to record patient height. We then retrospectively collected data on patient height and tidal volumes before and after the intervention. Results: We evaluated 51,404 tidal volume measurements in 1,826 patients over the 4 year study period; of these patients, 1,579 (86.5%) were pre-intervention and 247 (13.5%) were post-intervention. The intervention was associated with a odds of the patient's height being measured were 10 times higher post-intervention (25.1% vs 3.2%, P <0.05). After the bundle was initiated, we observed a significantly higher percentage of patients ventilated with mean tidal volumes less than 8 cubic centimeters per kilogram (93.9% vs 84.5% P < 0.05). Conclusion: Patients in an ED-ICU environment were ventilated with a lung-protective strategy more frequently after an intervention reminding RTs to measure actual patient height and providing a tape measure to do so. A significantly higher percentage of patients had height measured rather than estimated after the intervention, allowing for more accurate determination of ideal body weight and calculation of lung-protective ventilation volumes. Measuring all mechanically ventilated patients' height with a tape measure is an example of a simple, low-cost, scalable intervention in line with guidelines developed to improve the quality of care delivered to critically ill ED patients.
Databáze:	MEDLINE
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