title: A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality.
abstract: OBJECTIVE
  The purpose of the study is to determine if teleintensive care unit (ICU)-directed daily ventilator rounds improved adherence to lung protective ventilation (LPV), reduced ventilator duration ratio (VDR), and ICU mortality ratios.
  A retrospective observational longitudinal quarterly analysis of adherence to low tidal volume LPV (<7.5 mL/kg predicted body weight; Pao2/fraction of inspired oxygen<300), ventilator duration, and ICU mortality ratios (Acute Physiology and Chronic Health Evaluation IV-adjusted). The teleICU practice used Philips (Andover, MA) VISICU eCareManagerTM (Andover, MA) platform, providing ICU care and process improvement.
  
  
  RESULTS
  Before ventilator rounds implementation, there was wide variation in hospital adherence to low tidal volume (29.5±18.2; range 10%-69%). Longitudinal improvement was seen across hospitals in the 3 Qs after implementation, reaching statistical significance by Q3 postimplementation (44.9±15.7; P<.002 by 2-tailed Fisher exact test), maintained at 2 subsequent Qs (48% and 52%; P<.001). Ventilator duration ratio also showed preimplementation variability (1.08±.34; range 0.71-1.90). After implementation, absolute and significant mean VDR reduction was observed (0.92±.28; -15.8%, P<.05). Intensive care unit mortality ratio demonstrated longitudinal improvement, reaching significance after the Q3 postimplementation (0.94 vs 0.67; P<.04), and this was sustained in the most recent Q analyzed (0.65; P<.03).
  
  
  CONCLUSIONS
  Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality.
authors.affiliation: Department of Medicine, Hofstra School of Medicine, Manhasset, NY; Advanced ICU Care Inc, St Louis, MO. Electronic address: Tkalb@icumedicine.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalb
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Raikhelkar
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Shelley
authors.initials: S
authors.lastname: Meyer
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Francis
authors.initials: F
authors.lastname: Ntimba
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Jason
authors.initials: J
authors.lastname: Thuli
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Gorman
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Kopec
authors.affiliation: Advanced ICU Care Inc, St Louis, MO.
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
mesh_terms: D018806:APACHE; D001835:Body Weight; D003422:Critical Care / Q000379:methods*; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D012121:Respiration, Artificial / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D013990:Tidal Volume; D016896:Treatment Outcome
keywords: ICU mortality ratio; Low tidal volume strategy; Lung protective ventilation; Mechanical ventilation; TeleICU; Telemedicine; Ventilation duration ratio