title: A complete audit cycle to assess adherence to a lung protective ventilation strategy.
abstract: There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (V t) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ≤30 cm H2O. The initial audit failed to meet this standard with V t's of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with V t's of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.
authors.affiliation: Department of Anaesthesia and Critical Care, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Joynes
authors.affiliation: Department of Anaesthesia and Critical Care, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Satinder
authors.initials: S
authors.lastname: Dalay
authors.affiliation: Department of Anaesthesia and Critical Care, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Jaimin M
authors.initials: JM
authors.lastname: Patel
authors.affiliation: Department of Anaesthesia and Critical Care, Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: Samia
authors.initials: S
authors.lastname: Fayek
keywords: Intensive care; protective; respiratory; tidal volume; ventilation