Understanding and Changing the Practice of Mechanical Ventilation in the Community

  • G. D. Rubenfeld
Conference paper
Part of the Update in Intensive Care Medicine book series (UICMSOFT)


Mechanical Ventilation Respir Crit Spontaneous Breathing Trial Ventilator Circuit Computerize Decision Support 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Chassin MR (1997) Assessing strategies for quality improvement. Health Aff (Millwood) 16:151–161CrossRefGoogle Scholar
  2. 2.
    Chassin MR, Galvin RW (1998) The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 280:1000–1005CrossRefPubMedGoogle Scholar
  3. 3.
    Veninga CC, Lagerlov P, Wahlstrom R, et al (1999) Evaluating an educational intervention to improve the treatment of asthma in four European countries. Drug Education Project Group. Am J Respir Crit Care Med 160:1254–1262PubMedGoogle Scholar
  4. 4.
    Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr (1989) Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study. JAMA 262:3298–3302PubMedGoogle Scholar
  5. 5.
    Udvarhelyi IS, Jennison K, Phillips RS, Epstein AM (1991) Comparison of the quality of ambulatory care for fee-for-service and prepaid patients. Ann Intern Med 115:394–400PubMedGoogle Scholar
  6. 6.
    Heinig SJ, Quon AS, Meyer RE, Korn D (1999) The changing landscape for clinical research. Acad Med 74:726–745PubMedGoogle Scholar
  7. 7.
    Institute of Medicine (2001) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. National Academy Press, WashingtonGoogle Scholar
  8. 8.
    Kaye W (1995) Research on ACLS training—which methods improve skill & knowledge retention? Respir Care 40:538–546PubMedGoogle Scholar
  9. 9.
    Ely EW, Meade MO, Haponik EF, et al (2001) Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines. Chest 120(6 Suppl):454S–463SPubMedGoogle Scholar
  10. 10.
    Meade MO, Ely EW (2002) Protocols to improve the care of critically ill pediatric and adult patients. JAMA 288:2601–2603CrossRefPubMedGoogle Scholar
  11. 11.
    David SP, Greer DS (2001) Social marketing: application to medical education. Ann Intern Med 134:125–127PubMedGoogle Scholar
  12. 12.
    Gelijns A, Dawkins HV (1994) Institute of Medicine (US) Committee on Technological Innovation in Medicine. Adopting New Medical Technology. National Academy Press, WashingtonGoogle Scholar
  13. 13.
    The Institute for Healthcare Improvement. Available at: Scholar
  14. 14.
    Davis DA, Taylor-Vaisey A (1997) Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ 157:408–416PubMedGoogle Scholar
  15. 15.
    Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. Br Med J 317:465–468Google Scholar
  16. 16.
    Smith WR (2000) Evidence for the effectiveness of techniques to change physician behavior. Chest 118(2 Suppl):8S–17SPubMedGoogle Scholar
  17. 17.
    Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A (1999) Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 282:867–874PubMedGoogle Scholar
  18. 18.
    Krumholz HM, Radford MJ, Wang Y, Chen J, Heiat A, Marciniak TA (1998) National use and effectiveness of beta-blockers for the treatment of elderly patients after acute myocardial infarction: National Cooperative Cardiovascular Project. JAMA 280:623–629CrossRefPubMedGoogle Scholar
  19. 19.
    O’Connor GT, Quinton HB, Traven ND, et al (1999) Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project. JAMA 281:627–633PubMedGoogle Scholar
  20. 20.
    Mehta RH, Montoye CK, Gallogly M, et al (2002) Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA 287:1269–1276CrossRefPubMedGoogle Scholar
  21. 21.
    Cabana MD, Rand CS, Powe NR, et al (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465CrossRefPubMedGoogle Scholar
  22. 22.
    Payne TH (2000) Computer decision support systems. Chest 118:47S–52SCrossRefPubMedGoogle Scholar
  23. 23.
    Borbas C, Morris N, McLaughlin B, Asinger R, Gobel F (2000) The role of clinical opinion leaders in guideline implementation and quality improvement. Chest 118:24S–32SCrossRefPubMedGoogle Scholar
  24. 24.
    Alderson P, Schierhout G, Roberts I, Bunn F (2002) Colloids versus crystalloids for fluid resuscitation in critically ill patients (Cochrane Review). The Cochrane Library. Vol 1, Update Software, Oxford, CD:001208Google Scholar
  25. 25.
    Heyland DK, MacDonald S, Keefe L, Drover JW (1998) Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 280:2013–2019CrossRefPubMedGoogle Scholar
  26. 26.
    Rubenfeld GD (2001) Understanding why we agree on the evidence but disagree on the medicine. Respir Care 46:1442–1449PubMedGoogle Scholar
  27. 27.
    Curry SJ (2000) Organizational interventions to encourage guideline implementation. Chest 118(2 Suppl):40S–46SPubMedGoogle Scholar
  28. 28.
    Lo B (1995) Improving care near the end of life. Why is it so hard? JAMA 274:1634–1636CrossRefPubMedGoogle Scholar
  29. 29.
    Slutsky AS (1994) Consensus conference on mechanical ventilation—January 28–30, 1993 at Northbrook, Illinois, USA. Part 2. Intensive Care Med 20:150–162CrossRefPubMedGoogle Scholar
  30. 30.
    Slutsky AS (1994) Consensus conference on mechanical ventilation—January 28–30, 1993 at Northbrook, Illinois, USA. Part I. European Society of Intensive Care Medicine, the ACCP and the SCCM. Intensive Care Med 20:64–79CrossRefPubMedGoogle Scholar
  31. 31.
    Anonymous (1995) Consensus Conference III: Assessing innovations in mechanical ventilatory support. Conference held January 13–15, 1995 in Ixtapa, Mexico. Respir Care 40:926–993Google Scholar
  32. 32.
    Anonymous (1999) International consensus conferences in intensive care medicine: Ventilator-associated Lung Injury in ARDS. This official conference report was cosponsored by the American Thoracic Society, The European Society of Intensive Care Medicine, and The Societe de Reanimation de Langue Francaise, and was approved by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 160:2118–2124Google Scholar
  33. 33.
    Evans TW (2001) International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000. Intensive Care Med 27:166–178CrossRefPubMedGoogle Scholar
  34. 34.
    MacIntyre NR, Cook DJ, Ely EW Jr, et al (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120(6 Suppl):375S–395SPubMedGoogle Scholar
  35. 35.
    American Association for Respiratory Care (1992) ARC clinical practice guideline. Patient-ventilator system checks. Respir Care 37:882–886Google Scholar
  36. 36.
    Cohen IL, Lambrinos J (1995) Investigating the impact of age on outcome of mechanical ventilation using a population of 41,848 patients from a statewide database. Chest 107:1673–1680PubMedGoogle Scholar
  37. 37.
    Dewar DM, Kurek CJ, Lambrinos J, Cohen IL, Zhong Y (1999) Patterns in costs and outcomes for patients with prolonged mechanical ventilation undergoing tracheostomy: an analysis of discharges under diagnosis-related group 483 in New York State from 1992 to 1996. Crit Care Med 27:2640–2647PubMedGoogle Scholar
  38. 38.
    Kurek CJ, Dewar D, Lambrinos J, Booth FV, Cohen IL (1998) Clinical and economic outcome of mechanically ventilated patients in New York State during 1993: analysis of 10,473 cases under DRG 475. Chest 114:214–222PubMedGoogle Scholar
  39. 39.
    Kurek CJ, Cohen IL, Lambrinos J, Minatoya K, Booth FV, Chalfin DB (1997) Clinical and economic outcome of patients undergoing tracheostomy for prolonged mechanical ventilation in New York state during 1993: analysis of 6,353 cases under diagnosis-related group 483. Crit Care Med 25:983–988PubMedGoogle Scholar
  40. 40.
    Cohen IL, Lambrinos J, Fein IA (1993) Mechanical ventilation for the elderly patient in intensive care. Incremental changes and benefits. JAMA 269:1025–1029CrossRefPubMedGoogle Scholar
  41. 41.
    Esteban A, Anzueto A, Alia I, et al (2000) How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med 161:1450–1458PubMedGoogle Scholar
  42. 42.
    Esteban A, Anzueto A, Frutos F, et al (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355CrossRefPubMedGoogle Scholar
  43. 43.
    Bersten AD, Edibam C, Hunt T, Moran J, Group TA (2002) Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med 165:443–448PubMedGoogle Scholar
  44. 44.
    Luhr OR, Antonsen K, Karlsson M, et al (1999) Incidence and mortality after acute respiratory failure and acute respiratory distress syndrome in Sweden, Denmark, and Iceland. The ARF Study Group. Am J Respir Crit Care Med 159:1849–1861PubMedGoogle Scholar
  45. 45.
    Adams AB, Whitman J, Marcy T (1993) Surveys of long-term ventilatory support in Minnesota: 1986 and 1992. Chest 103:1463–1469PubMedGoogle Scholar
  46. 46.
    Gasperini M, Clini E, Zaccaria S (1998) Mechanical ventilation in chronic respiratory insufficiency: report on an Italian nationwide survey. The Italian Telethon Committee and the AIPO Study Group on Pulmonary Rehabilitation and Intensive Care. Monaldi Arch Chest Dis 53:394–399PubMedGoogle Scholar
  47. 47.
    Soo Hoo GW, Park L (2002) Variations in the measurement of weaning parameters: a survey of respiratory therapists. Chest 121:1947–1955CrossRefPubMedGoogle Scholar
  48. 48.
    Doherty MJ, Greenstone MA (1998) Survey of non-invasive ventilation (NIPPV) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) in the UK. Thorax 53:863–866PubMedGoogle Scholar
  49. 49.
    Sinuff T, Cook D, Randall J, Allen C (2000) Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital. CMAJ 163:969–973PubMedGoogle Scholar
  50. 50.
    Thomas SH, Orf J, Wedel SK, Conn AK (2002) Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice. J Trauma 52:47–52PubMedGoogle Scholar
  51. 51.
    Carmichael LC, Dorinsky PM, Higgins SB, et al (1996) Diagnosis and therapy of acute respiratory distress syndrome in adults: an international survey. J Crit Care 11:9–18PubMedGoogle Scholar
  52. 52.
    Mao C, Wong DT, Slutsky AS, Kavanagh BP (1999) A quantitative assessment of how Canadian intensivists believe they utilize oxygen in the intensive care unit. Crit Care Med 27:2806–2811PubMedGoogle Scholar
  53. 53.
    Faber-Langendoen K (1994) The clinical management of dying patients receiving mechanical ventilation. A survey of physician practice. Chest 106:880–888PubMedGoogle Scholar
  54. 54.
    Cook D, Ricard JD, Reeve B, et al (2000) Ventilator circuit and secretion management strategies: a Franco-Canadian survey. Crit Care Med 28:3547–3554PubMedGoogle Scholar
  55. 55.
    Ricard JD, Cook D, Griffith L, Brochard L, Dreyfuss D (2002) Physicians’ attitude to use heat and moisture exchangers or heated humidifiers: a Franco-Canadian survey. Intensive Care Med 28:719–725CrossRefPubMedGoogle Scholar
  56. 56.
    Heyland DK, Cook DJ, Dodek PM (2002) Prevention of ventilator-associated pneumonia: current practice in Canadian intensive care units. J Crit Care 17:161–167CrossRefPubMedGoogle Scholar
  57. 57.
    Ely EW, Bennett PA, Bowton DL, Murphy SM, Florance AM, Haponik EF (1999) Large scale implementation of a respiratory therapist-driven protocol for ventilator weaning. Am J Respir Crit Care Med 159:439–446PubMedGoogle Scholar
  58. 58.
    Cook DJ, Meade MO, Hand LE, McMullin JP (2002) Toward understanding evidence uptake: semirecumbency for pneumonia prevention. Crit Care Med 30:1472–1477PubMedGoogle Scholar
  59. 59.
    Ely EW, Baker AM, Dunagan DP, et al (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869CrossRefPubMedGoogle Scholar
  60. 60.
    East TD, Heermann LK, Bradshaw RL, et al (1999) Efficacy of computerized decision support for mechanical ventilation: results of a prospective multi-center randomized trial. Proc AMIA Symp 251–255Google Scholar
  61. 61.
    Pronovost PJ, Jenckes M, To M, et al (2002) Reducing failed extubations in the intensive care unit. Jt Comm J Qual Improv 28:595–604PubMedGoogle Scholar
  62. 62.
    Daly BJ, Rudy EB, Thompson KS, Happ MB (1991) Development of a special care unit for chronically critically ill patients. Heart Lung 20:45–51PubMedGoogle Scholar
  63. 63.
    Daly BJ, Phelps C, Rudy EB (1991) A nurse-managed special care unit. J Nurs Adm. 21:31–38PubMedGoogle Scholar
  64. 64.
    Cohen IL, Bari N, Strosberg MA, et al (1991) Reduction of duration and cost of mechanical ventilation in an intensive care unit by use of a ventilatory management team. Crit Care Med 19:1278–1284PubMedGoogle Scholar
  65. 65.
    Slotnick HB (2000) Physicians’ learning strategies. Chest 118:18S–23SeCrossRefPubMedGoogle Scholar
  66. 66.
    Weingarten S (2000) Translating practice guidelines into patient care: Guidelines at the bedside. Chest 118:4S–7SCrossRefPubMedGoogle Scholar
  67. 67.
    Kotler P, Roberto N (1989) Social Marketing: Strategies for Changing Public Behavior. Free Press, New YorkGoogle Scholar
  68. 68.
    Pervin LA (1970) Personality: Theory, Assessment, and Research. Wiley & Sons, New YorkGoogle Scholar
  69. 69.
    Rogers EM (1995) Diffusion of innovations. 4th ed. Free Press, New YorkGoogle Scholar
  70. 70.
    Soumerai SB, McLaughlin TJ, Gurwitz JH, et al (1998) Effect of local medical opinion leaders on quality of care for acute myocardial infarction — A randomized controlled trial. JAMA 279:1358–1363CrossRefPubMedGoogle Scholar
  71. 71.
    Deming WE (2000) Out of the Crisis. 1st MIT Press ed. MIT Press, CambridgeGoogle Scholar
  72. 72.
    Yamamoto LG, Wiebe RA, Matthews WJ Jr, Sia CC (1992) The Hawaii EMS-C project data: I. Reducing pediatric emergency morbidity and mortality; II. Statewide pediatric emergency registry to monitor morbidity and morality. Pediatr Emerg Care. 8:70–78PubMedGoogle Scholar
  73. 73.
    Grol R (1997) Personal paper: Beliefs and evidence in changing clinical practice. Br Med J 315:418–421Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • G. D. Rubenfeld

There are no affiliations available

Personalised recommendations