Practice variability in management of acute respiratory distress syndrome: bringing evidence and clinician education to the bedside using a web-based teaching tool.
BACKGROUND
Clinical practice often lags behind publication of evidence-based research and national consensus guidelines.


OBJECTIVE
To assess practice variability in the clinical management of acute respiratory distress syndrome (ARDS) and test an evidence-based, online clinician-education tool designed to improve intensive-care clinicians' understanding of current evidence about ARDS management.


METHODS
We surveyed 117 intensive care clinicians (16 critical care physician specialists, 28 resident physicians, 50 critical care nurses, and 23 respiratory therapists) with an online questionnaire in our tertiary academic institution. Fifty of the original respondents (12 residents, 26 critical care nurses, and 12 respiratory therapists) also responded to a repeat survey that included context-sensitive hypertext links to a summary of critically appraised primary articles regarding ARDS management, to determine if the responses changed after the clinicians had read the evidence-based summary information.


RESULTS
Critical care physician specialists were most likely to choose the low-tidal-volume (low-VT) ventilation strategy and protocol-based ventilator weaning and were least likely to choose neuromuscular blockade or parenteral nutrition (p < 0.05). In a paired comparison, individual respondents were more likely to choose treatment options that are based on stronger evidence (low-VT, daily interruption in sedation, and protocol weaning [p < 0.01]). We also reviewed the medical records of 100 patients who were mechanically ventilated for > 48 h, during the 6 months before and after the survey, from which we identified 45 ARDS patients. Following the clinician-education intervention, ARDS patients were less likely to receive potentially injurious high-VT ventilation (mean day-3 VT 10.3 +/- 2.3 mL/kg before vs 8.9 +/- 1.7 mL/kg after, p = 0.02).


CONCLUSIONS
Web-based teaching tools are useful to educate intensive-care practitioners and to promote evidence-based practice.
Department of Anesthesiology, Mayo Clinic, 200 First Street SW, 2-114 Old Marian Hall, Rochester MN 55905, USA. belda.thomas@mayo.edu.
Thomas E
TE
Belda
Ognjen
O
Gajic
Jeffrey T
JT
Rabatin
Barry A
BA
Harrison
D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods*; D003422:Critical Care / Q000592:standards; D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D008297:Male; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians' / Q000639:trends*; D018794:Problem-Based Learning; D011787:Quality of Health Care; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States