title: How to achieve adherence to a ventilation algorithm for critically ill children?
abstract: OBJECTIVE
  To evaluate to what extent physicians on a paediatric intensive care unit (PICU) adhered to a newly implemented ventilation algorithm.
  
  
  BACKGROUND
  PICUs worldwide use different ventilators with a wide variety of ventilation modes. We developed an algorithm, as part of a larger protocol, for choice of ventilation mode at time of admission.
  
  
  METHODS
  This study was performed in a level III PICU of a university children's hospital and had an uncontrolled, pre-post test design with a period before implementation (T0) and two periods after implementation (T1 and T2).
  
  
  METHODS
  An invasive ventilation algorithm targeted at two patient groups was implemented in October 2008. The algorithm distinguished between lung disease, in which pressure control was considered as the preferred mode, and no lung disease, in which pressure-regulated volume control was preferred. Nurses and physicians were instructed in the use of the algorithm before implementation.
  
  
  RESULTS
  During three test periods, a total of 507 children with a median age of 5 months [interquartile range (IQR) 0-50] on conventional invasive mechanical ventilation were included. In patients with lung disease, pre-implementation adherence rate was 79% (67/85). At T1 it was 71% (51/72); at T2 84% (46/55). The slight improvement from T1 to T2 was statistically not significant (p = 0·092). In patients with no lung disease, the adherence rate rose statistically significantly from 66% at T0 (62/93) to 78% (79/101) at T1, and 84% at T2 (85/101) (p = 0·015).
  
  
  CONCLUSIONS
  Implementation of a new ventilation algorithm increased physicians' adherence to this ventilation algorithm and the effect was sustained over time. This was achieved by education, reminders and organizational changes such as admission of postcardiac surgery patients with protocolized nursing care including preset ventilator settings.
  
  
  CONCLUSIONS
  Interdisciplinary collaboration, effective communication, leadership support and organizational aspects may be effective strategies to improve adherence to protocols.
authors.affiliation: Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Anita
authors.initials: A
authors.lastname: Duyndam
authors.affiliation: Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Houmes
authors.affiliation: Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
authors.affiliation: Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.affiliation: Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ista
mesh_terms: D000465:Algorithms; D002985:Clinical Protocols / Q000592:standards*; D003422:Critical Care / Q000592:standards*; D016638:Critical Illness; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008171:Lung Diseases; D008297:Male; D010820:Physicians; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*
keywords: Adherence; Algorithm; Guideline; Infants; Ventilation mode