The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

A RETROSPECTIVE CHART REVIEW OF LOW TIDAL VOLUME VENTILATION STRATEGY IN MEDICAL INTENSIVE CARE UNIT PATIENTS

Sarah Varekojis1, Natalie Bonomo1, Filomena Iacovone1, Christopher Phelps1, Naeem Ali2; 1Respiratory Therapy Division, The Ohio State University, Columbus, OH; 2Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Medical Center, Columbus, OH

Background: Patients with ALI and ARDS often receive low Vts (<6 mL/kg). This approach has not been widely adopted in a broad group of patients without ALI/ARDS. We sought to determine the effectiveness of an RT-driven ventilator management protocol in applying appropriate Vt settings. Methods: Retrospective chart review conducted involving MICU patients. A before-and-after implementation study design was chosen. Data collection included demographics, ALI/ARDS at intubation and 72 hrs post-intubation, ventilator settings, duration of mechanical ventilation, ABGs, ICU and hospital LOS. Descriptive statistics, t-tests and chi square used to determine appropriateness and safety of lower Vts in patients without ALI/ARDS. Results: There was a statistically significant decrease in the Vts utilized following implementation of the protocol that persisted for at least 72 hrs. Patients with ALI/ARDS were more likely to receive a Vt <6 mL/kg after implementation of the protocol, whereas there was a numeric increase in the proportion of non-ALI/ARDS pts receiving <8 ml/kg Vt, suggesting a strong trend toward personalized ventilator initiation. While PEEP levels appeared numerically higher, they were not significantly different with implementation of the protocol. There appeared to be a trend to worsened oxygenation at 72 hrs. However, survival was no different between the groups or for subjects receiving appropriate Vt, suggesting a lack of harm. There was no statistically significant difference in ventilator days, plateau pressures, FiO2, or PaO2/FiO2 ratios in the 2008 non-ALI/ARDS cohort. Conclusion: Implementation of an RT-driven ventilator management protocol had a statistically significant impact on the Vts used at initiation of MV largely because of a significant improvement in appropriate Vt for ALI/ARDS patients. However, delivery of appropriate Vt for non-ALI/ARDS patients also increased. A trend toward improved survival for patients receiving appropriate Vt in our cohort confirms that this approach is safe and consistent with findings in larger RCTs. The use of a protocol can effectively reduce the prescribed Vt for all patients, and can provide some personalization of Vt settings based on disease process. This reduction appears well tolerated as the Vts remained consistently lower for at least 3 days without difference in ventilator or survival outcome. Low Vt practices appear to be appropriate and safe for non-ALI/ARDS populations in the MICU. Sponsored Research - None

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