Barriers to providing lung-protective ventilation to patients with acute lung injury.
OBJECTIVE
No studies have explored the barriers to implementing lung-protective ventilation in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Our objective was to identify barriers to using lung-protective ventilation in patients with ALI/ARDS.


METHODS
Survey with content analysis of open-ended responses.


METHODS
Medical center.


METHODS
Experienced intensive care unit nurses and respiratory therapists network identified through purposive sampling at hospitals from the ARDS Network, a National Institutes of Health-sponsored research consortium.


METHODS
Survey.


RESULTS
Fifty-five surveys representing all ten ARDS Network sites were received. Twenty-seven (49%) of the respondents were intensive care unit nurses, 24 (44%) were respiratory therapists, and four did not indicate their profession. Clinicians had used lung-protective ventilation in a median of 20 (interquartile range, 10-50) patients with ALI/ARDS. Respondents identified physician willingness to relinquish control of ventilator, physician recognition of ALI/ARDS, and physician perceptions of patient contraindications to low tidal volumes as important barriers to initiating lung-protective ventilation. Important barriers to continuing patients on lung-protective ventilation were concerns over patient discomfort and tachypnea and concerns over hypercapnia, acidosis, and hypoxemia. Techniques for overcoming barriers were identified including specific ventilator setup recommendations, clinician education, and tools to assess patient discomfort.


CONCLUSIONS
Experienced bedside clinicians perceive important barriers to implementing lung-protective ventilation. Successful strategies to increase use of lung-protective ventilation should target these barriers.
Rubenfeld
Gordon D
GD
Pulmonary and Critical Care Medicine Division, Harborview Medical Center, University of Washington, Seattle, USA.
Cooper
Claudette
C
Carter
Greg
G
Thompson
B Taylor
BT
Hudson
Leonard D
LD
D001291:Attitude of Health Personnel; D000075202:Contraindications; D003625:Data Collection; D007362:Intensive Care Units; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*