Feedback and education improve physician compliance in use of lung-protective mechanical ventilation.
OBJECTIVE
Use of lung-protective mechanical ventilation (MV) by applying lower tidal volumes is recommended in patients suffering from acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Recent data suggest that lung-protective MV may benefit non-ALI/ARDS patients as well. This study analyzed tidal volume settings in three ICUs in The Netherlands to determine the effect of feedback and education concerning use of lung-protective MV.


METHODS
Observational study in one academic and two nonacademic "closed format" ICUs.


METHODS
Intubated mechanically ventilated subjects.


METHODS
Feedback and education concerning lung-protective MV with special attention to the importance of closely adjusting tidal volumes to predicted body weight (PBW).


RESULTS
Tidal volumes declined significantly within 6 months after intervention (from 9.8+/-2.0 at baseline to 8.1+/-1.7 ml/kg PBW) as the percentage of undesirable ventilation data points, defined as tidal volumes greater than 8 ml/kg PBW (84% vs. 48%). There were no differences between patients meeting the international definition criteria for ALI/ARDS and those not. Only four patients received tidal volumes less than 6 ml/kg PBW. Lower tidal volumes were still used after 12 months. Tidal volumes in patients on mandatory MV and patients breathing on spontaneous modes were similar.


CONCLUSIONS
Feedback and education improve physician compliance in use of lung-protective MV.
Wolthuis
Esther K
EK
Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. e.k.wolthuis@amc.uva.nl
Korevaar
Johanna C
JC
Spronk
Peter
P
Kuiper
Michael A
MA
Dzoljic
Misa
M
Vroom
Margreeth B
MB
Schultz
Marcus J
MJ
D000368:Aged; D000369:Aged, 80 and over; D004496:Education, Continuing; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000517:prevention & control* / Q000628:therapy; D013990:Tidal Volume
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