title: Barriers to providing lung-protective ventilation to patients with acute lung injury.
abstract: 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.
authors.affiliation: Pulmonary and Critical Care Medicine Division, Harborview Medical Center, University of Washington, Seattle, USA.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.forename: Claudette
authors.initials: C
authors.lastname: Cooper
authors.forename: Greg
authors.initials: G
authors.lastname: Carter
authors.forename: B Taylor
authors.initials: BT
authors.lastname: Thompson
authors.forename: Leonard D
authors.initials: LD
authors.lastname: Hudson
mesh_terms: D001291:Attitude of Health Personnel; D000075202:Contraindications; D003625:Data Collection; D007362:Intensive Care Units; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000628:therapy*