title: Guideline implementation powered by feedback and education improves manual hyperinflation performance.
abstract: OBJECTIVE
  To determine whether a literature-based guideline, powered by educational meetings and individual feedback, improves manual hyperinflation (MH) performance by intensive care unit (ICU) nurses.
  
  
  BACKGROUND
  MH is frequently applied in intubated and mechanically ventilated ICU patients. MH is a complex intervention, and large variation in its performance has been found.
  
  
  METHODS
  First, a literature-based guideline on MH was developed. The intervention consisted of education of this guideline and individual feedback. Before and 3 months after the intervention, ICU nurses performed MH maneuvers in a skills laboratory. Data collected included applied volumes, peak inspiratory flows (PIF) and peak expiratory flows (PEF), and the use of inspiratory holds.
  
  
  RESULTS
  Eighty nurses participated. Decrease of PIF was not statistically significant. PEF increased from 52 ± 7 to 83 ± 23 L/min (P < 0·01). PIF to PEF ratio decreased from 1·4 [1·1-1·7] to 0·8 [0·6-1·1] (P < 0·01). Peak inspiratory pressures decreased from 40 ± 14 to 19 ± 6 cm H2 O (P < 0·01). The proportion of nurses applying inspiratory holds increased from 14% to 58%; use of rapid release of the resuscitation bag, considered mandatory, increased from 4% to 61%.
  
  
  CONCLUSIONS
  Implementation of a literature-based guideline on MH, powered by educational meetings and individual feedback, improves MH performance by ICU nurses.
  
  
  CONCLUSIONS
  If it is decided to practice MH in the care of the intubated and mechanical ventilated patient, a standardized, uniform performed MH procedure is a prerequisite.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frederique
authors.initials: F
authors.lastname: Paulus
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pauline
authors.initials: P
authors.lastname: Middelhoek
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Margreeth B
authors.initials: MB
authors.lastname: Vroom
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Laboratory for Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: SchuItz
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards; D003422:Critical Care; D005246:Feedback; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009741:Nursing Staff, Hospital / Q000193:education*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012121:Respiration, Artificial / Q000295:instrumentation / Q000379:methods*
keywords: Critical care nursing; Education and training of ICU nurses; Respiratory care