The Science Journal of the American Association for Respiratory Care
INTRODUCTION/HYPOTHESIS: Respiratory Care Service at our institution provides approximately 40,000 hours of mechanical ventilation per month to adult patients. We were concerned that clinical practice was inconsistent and practitioner awareness of potentially harmful ventilator settings was lacking. We hypothesized that by identifying potentially harmful ventilator settings and subsequently educating practitioners, we could improve clinical outcome and consistency in the management of mechanically ventilated patients. EVALUATION METHOD: Five undesirable ventilator parameters were identified: FIO2 > 0.60, Plateau pressures > 35 cm H2O, Presence of auto-PEEP, Patient-ventilator dyssynchrony, and lack of weaning when weaning criteria is met. Initial data was collected on 159 mechanically ventilated patients and revealed that 55 (35%) had at least one undesirable parameter present. INTERVENTION: Training was conducted for all intensive care practitioners. Course curriculum included target settings, modes of ventilation, considerations for weaning (stable hemodynamcis with systolic BP > 90 and Dopamine < 5 mcg/kg/min; stable hemoglobin with PaO2 > than 60 on 40% O2; spontaneous respiratory rate < 30 bpm and no neuromuscular blockers) and ventilator graphics. Practitioners attended four-hour workshops and were required to pass a written exam inclusive of graphic interpretation and case studies. The department information system was also configured to mandate documentation of the five undesirable parameters with each ventilator monitoring round. The desired target was 90% of all ventilator settings to be within optimal range, and that 95% of patients meeting weaning criteria were actively being weaned.
Results: Monthly averages of undesirable ventilator parameters from August 1998 and March 1999 (total of 4692 parameter entries) illustrate substantial performance improvement after the intervention:
|Month||%FIO2<.60||%Plat Press<35||%No autoPEEP||%No Dysn.||%Appr. wean|
By identifying potentially harmful settings, providing practitioner training and requiring continued monitors, clinical outcome and consistency has improved with mechanically ventilated patients.