title: Adoption of lower tidal volume ventilation improves with feedback and education.
abstract: OBJECTIVE
  To determine whether feedback and education improve adoption of lung-protective mechanical ventilation (ie, with lower tidal volume [V(T)]).
  
  
  METHODS
  We conducted a retrospective study of ventilator settings; we used data from 3 consecutive studies of patients with acute lung injury and/or acute respiratory distress syndrome, in the intensive care units of 2 university hospitals in the Netherlands. At site 1 we conducted a time series study of before and after education and feedback about lung-protective mechanical ventilation, and we compared the results from site 1 to the ventilation strategies used at site 2, which did not undergo the education and feedback intervention. Feedback and education consisted of presentations of actual ventilator settings, advised ventilator settings, and discussions on potential reasons for not using lower V(T).
  
  
  RESULTS
  Two studies were performed at site 1, in 1999-2000 (Study 1, n = 22) and in 2002 (Study 2, n = 12). In 2003-2004, Study 3 was performed simultaneously at site 1 (n = 8) and site 2 (n = 17). At site 1, the mean +/- SD V(T) was 10.9 mL/kg predicted body weight (PBW) (95% CI 10.3-11.6) in Study 1 and 9.9 mL/kg PBW (95% CI 9.0-10.8) in Study 2 (difference not significant). After the feedback and education intervention at site 1, V(T) declined to 7.6 mL/kg PBW (95% CI 6.5-8.7) in Study 3 (p = 0.003). At site 2, where no feedback or education were given, V(T) was 10.3 mL/kg PBW (95% CI 9.5-11.0) in Study 3 (p < 0.001 vs Site 1).
  
  
  CONCLUSIONS
  Adoption of a lower-V(T) ventilation strategy in patients with acute lung injury or acute respiratory distress syndrome is far from complete in the Netherlands. Adoption of a lower-V(T) strategy improves after feedback and education.
authors.affiliation: Department of Intensive Care Medicine, C3-329, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. e.k.wolthuis@amc.uva.nl
authors.forename: Esther K
authors.initials: EK
authors.lastname: Wolthuis
authors.forename: Jozef
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: Luc H
authors.initials: LH
authors.lastname: Hassink
authors.forename: Rogier M
authors.initials: RM
authors.lastname: Determann
authors.forename: Johanna C
authors.initials: JC
authors.lastname: Korevaar
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
mesh_terms: D000328:Adult; D000368:Aged; D004059:Diffusion of Innovation; D005246:Feedback; D005260:Female; D006801:Humans; D007362:Intensive Care Units; 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; D012189:Retrospective Studies; D013990:Tidal Volume / Q000502:physiology*