%0 Journal Article %A Sidharth Bagga %A Dalton E. Paluzzi %A Christine Y. Chen %A Jeffrey M. Riggio %A Manjula Nagaraja %A Paul E. Marik %A Michael Baram %T Improved compliance with lower tidal volumes for initial ventilation setting- using a Computerized Clinical Decision Support System. %D 2013 %R 10.4187/respcare.02223 %J Respiratory Care %P respcare.02223 %X Background: The ARDSnet-low tidal volume (Vt) trial paved the ground for mechanically ventilating patients with Acute Respiratory Distress Syndrome (ARDS) with Vt of 6 ml/kg ideal body weight [IBW]. Although there is no consensus that a low Vt is advantageous in non-ARDS patients, it is accepted that high Vt should be avoided. Since compliance rates of ventilator recommendations are thirty-percent, there is a need for process improvement. We postulated that a computerized screen prompt that recommended Vt based on height would improve compliance with the low Vt. During ventilator order entry, the computerized decision tool prompts the clinician and encourages ventilation of patients at 8cc/kg IBW, and 6cc/kg IBW for patients with ARDS. Methods: A retrospective review was performed on patients who required volume controlled mechanical ventilation over a three-year period. Patients were chosen randomly from the respiratory records of six different ICUs at a single tertiary care academic center. Half of the charts selected were prior to intervention of on screen prompt and the other half were post implementation of the computerized decision tool. Results: The initial set tidal volumes ranged from 6.26 to 13.45 cc/kg IBW with a mean of 8.92 cc/kg. After implementation of the on-screen prompt, mean tidal volume decreased by 0.84 ml/kg to 8.07 cc/kg (p value = 0.0011) with range lower at 4.73 to 11.56 cc/kg IBW. We also noted a significant decrease in the number of patients placed on an initial tidal volume greater than 10 ml/kg IBW from 20% to 4%, p=0.003. Conclusion: A computerized clinical decision tool with the preferred initial tidal volume settings based on the patients’ sex and height is a safe and reliable way to increase low Vt strategy compliance across multiple ICUs. Its limitations are similar to those shared by other computer-generated prompts. %U https://rc.rcjournal.com/content/respcare/early/2013/12/03/respcare.02223.full.pdf