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Abstract
BACKGROUND: Mechanical ventilation is a common life-saving procedure but can lead to serious complications, including ARDS and oxygen toxicity. Nonadherence to lung-protective ventilation guidelines is common. We hypothesized that a respiratory therapist–driven mechanical ventilation bundle could increase adherence to lung-protective ventilation and decrease the incidence of pulmonary complications in the ICU.
METHODS: A respiratory therapist–driven protocol was implemented on August 1, 2018, in all adult ICUs of a Midwestern academic tertiary center. The protocol targeted low tidal volume, adequate PEEP, limiting oxygen, adequate breathing frequency, and head of the bed elevation. Adherence to lung-protective guidelines and clinical outcomes were retrospectively observed in adult subjects admitted to the ICU and on ventilation for ≥ 24 h between January 2011 and December 2019.
RESULTS: We included 666 subjects; 68.5% were in the pre-intervention group and 31.5% were in the post-intervention group. After adjusting for body mass index and intubation indication, a significant increase in overall adherence to lung-protective ventilation guidelines was observed in the post-intervention period (adjusted odds ratio 2.48, 95% CI 1.73–3.56). Fewer subjects were diagnosed with ARDS in the post-intervention group (adjusted odds ratio 0.22, 95% CI 0.08–0.65) than in the pre-intervention group. There was no difference in the incidence of ventilator-associated pneumonia, ventilator-free days, ICU mortality, or death within 1 month of ICU discharge.
CONCLUSIONS: A respiratory therapist–driven protocol increased adherence to lung-protective mechanical ventilation guidelines in the ICU and was associated with decreased ARDS incidence.
Footnotes
- Correspondence: Dr Alaina Berg, University of Iowa Carver College of Medicine, 200 Hawkins Drive 1008 RCP, Iowa City, IA 52242. E-mail: alaina-berg{at}uiowa.edu
Dr Berg and Dr Evans are co-first authors.
The authors have disclosed no conflicts of interest.
This work was supported by the Department of Emergency Medicine of the University of Iowa Hospitals and Clinics.
A version of this paper was presented by Dr Berg at SCCM 2023 held in San Francisco, California, January 21–24, 2023.
The study location was University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Supplementary material related to this paper is available at http://www.rcjournal.com.
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