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Critical Care |

Prompting to Reduce the Use of Excessive Tidal Volumes During Mechanical Ventilation for Adults

Carlos Viteri Yaquian, MD; Kavitha Gopalratnam, MD; Fadi Aldaas, MD; Inga Forde, MD; David Kaufman, MD
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Bridgeport Hospital, Bridgeport, CT


Chest. 2015;148(4_MeetingAbstracts):315A. doi:10.1378/chest.2236815
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Abstract

SESSION TITLE: Mechanical Ventilation and Respiratory Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The use of excessive tidal volumes (TV) during mechanical ventilation has been strongly associated with lung and distal organ damage. The protective effect of low-volume ventilation has been shown in patients with and without established acute respiratory distress syndrome. The purpose of this study was to assess the use of excessive TV during mechanical ventilation of adults in the intensive care unit (ICU) and to evaluate the effectiveness of a verbal prompting system in reducing this potentially harmful practice.

METHODS: During the initial phase electronic medical records were reviewed retrospectively for all patients ventilated for 2 or more days in the three ICUs of a community teaching hospital between May and October, 2014. Demographic characteristics, ventilation settings for the first 7 days, and outcomes (total days on ventilator and survival to discharge) were analyzed. During the intervention phase, ventilated patients were followed prospectively between January and March, 2015 recording the same variables. When high TV (≥8 mL/kg of ideal body weight) was detected the primary team was prompted (but not obligated) to decrease it.

RESULTS: A total of 168 ventilation-events were included in the baseline analysis; the incidence of high-volume ventilation (HVV; ≥3 days with TV above threshold) was 25.0%, while 26.8% of all recorded TV were higher than threshold. HVV was associated with longer length of mechanical ventilation (7.8 vs 16.9 days; p=0.006) but not with a difference in mortality. During the intervention phase 84 ventilation-events were analyzed. At least one high TV was noted in 20 patients. Nine of the 15 patients that received intervention had a reduction in TV, but this reduction was sufficient to cross the threshold in only 5. The percentage of high-TV readings decreased in the intervention phase (26.7 vs 15.8%, p<0.0001) and the incidence of HVV showed a decreasing trend (25.0 vs 16.7%, p=0.14). Total days on ventilation and mortality did not change significantly.

CONCLUSIONS: The use of potentially harmful TV is common in the mechanical ventilation of adults in the ICU setting and is associated with a longer duration of mechanical ventilation. Verbal prompting was associated with a reduction in high TV use.

CLINICAL IMPLICATIONS: A verbal system prompting providers to use “safe” TV appears to have some effectiveness in the reduction of HVV. Integration of the prompting system to the electronic medical record may be effective and should be a component of a larger effort to limit HVV.

DISCLOSURE: The following authors have nothing to disclose: Carlos Viteri Yaquian, Kavitha Gopalratnam, Fadi Aldaas, Inga Forde, David Kaufman

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