A complete audit cycle to assess adherence to a lung protective ventilation strategy

• Published in: Indian journal of critical care medicine Vol. 18; no. 11; pp. 746 - 749
• Main Authors: Joynes, Emma, Dalay, Satinder, Patel, Jaimin M, Fayek, Samia
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.11.2014; Jaypee Brothers Medical Publishers Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Acute respiratory distress syndrome; Artificial respiration; Audits; Brief Communication; Care and treatment; Compliance; Education; Hospitals; Intensive care; Lungs; Medical protocols; Mortality; Nurses; Nursing; Patients; Respiratory distress syndrome; Studies; Ventilation; Intensive care; protective; tidal volume; respiratory; ventilation
• ISSN: 0972-5229; 1998-359X
• DOI: 10.4103/0972-5229.144020

There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (V t) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ≤30 cm H2O. The initial audit failed to meet this standard with V t's of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with V t's of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.