Critical Care: Mechanical Ventilation & Respiratory Failure II |

Tidal Volume, Predicted Body Weight, and Modes of Mechanical Ventilation FREE TO VIEW

Keith Lamb, RRT; Trevor Oetting, RRT; Julie Jackson, RRT; Gregory Hicklin, MD
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UnityPoint Health, Iowa, Des Moines, IA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):322A. doi:10.1016/j.chest.2016.08.335
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SESSION TITLE: Mechanical Ventilation & Respiratory Failure II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this study was to evaluate compliance of utilizing appropriate tidal volumes and modes of ventilation in patients with respiratory failure.

METHODS: This is a retrospective analysis of a before and after interventional performance improvement project. 400 intubated patients were studied. 200 patients were evaluated before intervention and 200 were evaluated after the intervention. Intervention consisted of education and resources provided to ICU staff. Primary outcomes measurements were adherence to ARDSnet low tidal volume guidelines including appropriate tidal volume selection and controlled ventilation (volume or pressure). All statistical analyses were performed with IBM SPSS Basic Statistics for Windows, version 20.0 (IBM Corp, 2011). All statistical tests were based on a 0.05 significance level.

RESULTS: We collected service demographics, tidal volume sizes, modes of ventilation and oxygenation indices. Additionally, mortality was evaluated for each group and sub-group. All data were calculated and compared between phase one and phase two. Use of tidal volumes > 8ml/kg/pbw was (63%) phase one, (29%) phase two (p <.001), Tidal volumes ≥ 6ml and ≤ 8ml (34%) phase one, (63%) phase two (p <.001). The use of Pressure Regulated Volume Control (PRVC) was utilized in (77%) of patients phase one, and (18%) phase two (p <.001). Volume Controlled Ventilation was used in (5%) of patients phase one and (74%) Phase two (p <0.001). Acuity levels as they relate to respiratory failure were assigned by determining the number of patients that had a P/F ratio of ≤ 100. This was (4%) in phase one and (7%) in phase two (p 0.19) with mortality rates of (25%) and (64%) respectively (p < 0.05).

CONCLUSIONS: Through organized educational efforts and surveillance of practice patterns our respiratory care department in conjunction with other practicing critical care clinicians were able to bring practice patterns into much closer proximity to the available published literature. The acuity level of our critical care census was almost double in the phase two patients, and despite this the mortality difference between each group did not reach statistical significance. This would seem to support that these efforts potentially effected outcomes in a positive way. This requires further investigation.

CLINICAL IMPLICATIONS: Clinical implications include a much better compliance to accepted standards (already supported by the evidence) of mechanical ventilation practice patterns which in turn will improve patient outcomes.

DISCLOSURE: The following authors have nothing to disclose: Keith Lamb, Trevor Oetting, Julie Jackson, Gregory Hicklin

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