title: Evaluation of an intervention to reduce tidal volumes in ventilated ICU patients.
abstract: BACKGROUND
  There is considerable evidence that the use of tidal volumes <6 ml kg(-1) predicted body weight (PBW) reduces mortality in mechanically ventilated patients. We evaluated the effectiveness of using a large screen displaying delivered tidal volume in ml kg(-1) (PBW) for reducing tidal volumes.
  
  
  METHODS
  We assessed the intervention in two 6-month periods. A qualitative study was undertaken after the intervention period to examine staff interaction with the intervention. The study was conducted in a mixed medical and surgical intensive care unit at University Hospitals Bristol, UK. Consecutive patients requiring controlled mechanical ventilation for more than 1 h were included. Alerts were triggered when tidal volume breached predetermined targets and these alerts were visible to ICU clinicians in real time.
  
  
  RESULTS
  A total of 199 patients with 7640 h of data were observed during the control time period and 249 patients with 10 656 h of data were observed in the intervention period. Time spent with tidal volumes <6 ml kg(-1) PBW increased from 17.5 to 28.6% of the period of controlled mechanical ventilation. Time spent with a tidal volume <8 ml kg(-1) PBW increased from 60.6 to 73.9%. The screens were acceptable to staff and stimulated an increase in attendance of clinicians at the bedside to adjust ventilators.
  
  
  CONCLUSIONS
  Changing the format of data and displaying it with real-time alerts reduced delivered tidal volumes. Configuring information in a format more likely to result in desired outcomes has the potential to improve the translation of evidence into practice.
authors.affiliation: Intensive Care Unit, Queens Building, University Hospitals Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK chrisbourdeaux@gmail.com christopher.bourdeaux@uhbristol.nhs.uk.
authors.forename: C P
authors.initials: CP
authors.lastname: Bourdeaux
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK.
authors.forename: K
authors.initials: K
authors.lastname: Birnie
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK.
authors.forename: A
authors.initials: A
authors.lastname: Trickey
authors.affiliation: Intensive Care Unit, Queens Building, University Hospitals Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK.
authors.forename: M J C
authors.initials: MJ
authors.lastname: Thomas
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sterne
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Donovan
authors.affiliation: Faculty of Health and Life Sciences, University of the West of England, Glenside Campus, Bristol BS16 1DD, UK.
authors.forename: J
authors.initials: J
authors.lastname: Benger
authors.affiliation: Independent Researcher, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Brandling
authors.affiliation: Intensive Care Unit, Queens Building, University Hospitals Bristol, Upper Maudlin Street, Bristol BS2 8HW, UK.
authors.forename: T H
authors.initials: TH
authors.lastname: Gould
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D036301:Qualitative Research; D012121:Respiration, Artificial; D013990:Tidal Volume; D013997:Time Factors
keywords: acute respiratory distress syndrome; behavioural economics; computerised decision support systems; lung protective ventilation; quality improvement