title: Lung protection: an intervention for tidal volume reduction in a teaching intensive care unit.
abstract: To determine the effect of feedback and education regarding the use of predicted body weight to adjust tidal volume in a lung-protective mechanical ventilation strategy.
  The study was performed from October 2014 to November 2015 (12 months) in a single university polyvalent intensive care unit. We developed a combined intervention (education and feedback), placing particular attention on the importance of adjusting tidal volumes to predicted body weight bedside. In parallel, predicted body weight was estimated from knee height and included in clinical charts.
  One hundred fifty-nine patients were included. Predicted body weight assessed by knee height instead of visual evaluation revealed that the delivered tidal volume was significantly higher than predicted. After the inclusion of predicted body weight, we observed a sustained reduction in delivered tidal volume from a mean (standard error) of 8.97 ± 0.32 to 7.49 ± 0.19mL/kg (p < 0.002). Furthermore, the protocol adherence was subsequently sustained for 12 months (delivered tidal volume 7.49 ± 0.54 versus 7.62 ± 0.20mL/kg; p = 0.103).
  The lack of a reliable method to estimate the predicted body weight is a significant impairment for the application of a worldwide standard of care during mechanical ventilation. A combined intervention based on education and repeated feedbacks promoted sustained tidal volume education during the study period (12 months).
authors.affiliation: Unidade de Terapia Intensiva, Hospital de Clínicas, Universidad de la República - Montevidéu, Uruguai.|Área de Investigação Respiratória, Departamento de Fisiopatologia, Hospital de Clínicas - Montevidéu, Uruguai.
authors.forename: Arturo
authors.initials: A
authors.lastname: Briva
authors.affiliation: Unidade de Terapia Intensiva, Hospital de Clínicas, Universidad de la República - Montevidéu, Uruguai.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gaiero
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D003422:Critical Care / Q000379:methods*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007717:Knee / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume