Intensive Care Medicine

, Volume 31, Issue 4, pp 540–546

Feedback and education improve physician compliance in use of lung-protective mechanical ventilation

  • Esther K. Wolthuis
  • Johanna C. Korevaar
  • Peter Spronk
  • Michael A. Kuiper
  • Misa Dzoljic
  • Margreeth B. Vroom
  • Marcus J. Schultz
Original

DOI: 10.1007/s00134-005-2581-9

Cite this article as:
Wolthuis, E.K., Korevaar, J.C., Spronk, P. et al. Intensive Care Med (2005) 31: 540. doi:10.1007/s00134-005-2581-9

Abstract

Objective

Use of lung-protective mechanical ventilation (MV) by applying lower tidal volumes is recommended in patients suffering from acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Recent data suggest that lung-protective MV may benefit non-ALI/ARDS patients as well. This study analyzed tidal volume settings in three ICUs in The Netherlands to determine the effect of feedback and education concerning use of lung-protective MV.

Design and setting

Observational study in one academic and two nonacademic “closed format” ICUs.

Patients

Intubated mechanically ventilated subjects.

Interventions

Feedback and education concerning lung-protective MV with special attention to the importance of closely adjusting tidal volumes to predicted body weight (PBW).

Results

Tidal volumes declined significantly within 6 months after intervention (from 9.8±2.0 at baseline to 8.1±1.7 ml/kg PBW) as the percentage of undesirable ventilation data points, defined as tidal volumes greater than 8 ml/kg PBW (84% vs. 48%). There were no differences between patients meeting the international definition criteria for ALI/ARDS and those not. Only four patients received tidal volumes less than 6 ml/kg PBW. Lower tidal volumes were still used after 12 months. Tidal volumes in patients on mandatory MV and patients breathing on spontaneous modes were similar.

Conclusions

Feedback and education improve physician compliance in use of lung-protective MV.

Keywords

Respiration, artificial Respiratory distress syndrome, adult Tidal volume 

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Esther K. Wolthuis
    • 1
    • 2
  • Johanna C. Korevaar
    • 3
  • Peter Spronk
    • 4
  • Michael A. Kuiper
    • 5
  • Misa Dzoljic
    • 2
  • Margreeth B. Vroom
    • 1
  • Marcus J. Schultz
    • 1
  1. 1.Department of Intensive Care MedicineAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of AnesthesiologyAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Clinical Epidemiology and BiostatisticsAcademic Medical CenterAmsterdamThe Netherlands
  4. 4.Department of Intensive Care MedicineGelre HospitalApeldoornThe Netherlands
  5. 5.Department of Intensive Care MedicineMedical Center LeeuwardenLeeuwardenThe Netherlands

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