The impact of an education program and written guideline on adherence to low tidal volume ventilation.
BACKGROUND
Low tidal volume ventilation reduces mortality in patients with acute lung injury (ALI) and may reduce the risk of ALI in ventilated patients. A previous audit of our ventilation practices showed poor adherence to low tidal volume ventilation, and we subsequently introduced written ventilation guidelines and an education program to change practice.


OBJECTIVE
To determine if adherence to low tidal volume ventilation (defined as mandatory tidal volumes of =?6.5 mL/ kg predicted body weight [PBW]) in ventilated patients was improved with a written guideline and staff education.


METHODS
Retrospective analysis of recorded mandatory ventilator settings from the clinical information system of a tertiary referral intensive care unit from 1 January 2012 to 31 December 2015, involving analysis of mandatory ventilator settings in relation to PBW to determine adherence to guidelines, and interrupted time-series analysis to assess the impact of education.


METHODS
Adherence to low tidal volume ventilation.


RESULTS
The mean tidal volume for the cohort was 7.4 mL/ kg (SD, 1.3 mL/kg) PBW, and 760 patients (26.9%) received an average tidal volume during mandatory ventilation of ≤6.5 mL/kg PBW. Interrupted time-series analysis showed improved adherence after education, with an increase in adherence of 29.4% (95% CI, 19.3%-39.5%) from baseline. Multivariate logistic analysis found height, weight and staff education, but not sex, were associated with adherence to low tidal volume ventilation.


CONCLUSIONS
Written protocols and education can influence clinician behaviour, with substantial improvements in adherence to low tidal volume ventilation. Efforts to improve adherence through ward-based education appear warranted and necessary. Adherence was strongly associated with patient height, which suggested that adherence was partly the result of chance rather than design.
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia. antony.tobin@svha.org.au.
Celeste
C
Nota
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
John D
JD
Santamaria
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
David
D
Reid
Department of Critical Care Medicine, St Vincent's Hospital, Melbourne, VIC, Australia.
Antony E
AE
Tobin
D055371:Acute Lung Injury / Q000628:therapy*; D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007318:Inservice Training; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013990:Tidal Volume