The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

DEVELOPING, IMPLEMENTING, AND ASSESSING AIRWAY PRESSURE RELEASE VENTILATION GUIDELINES IN THE PEDIATRIC INTENSIVE CARE UNIT.

Tammy Schultz, Grace Arteaga, Grant Wilson; Mayo Clinic, Rochester, MN

Background: Pediatric Respiratory Care at the Mayo Clinic developed and initiated “Airway Pressure Release Ventilation (APRV) guidelines” in the Pediatric Intensive Care Unit (PICU). A multidisciplinary team recognized inconsistencies and knowledge deficit when initiating and adjusting APRV settings. The main goal in instituting APRV guidelines was to increase consistency when initiating and weaning APRV. Method: Information and content for the APRV guidelines was collected from researching evidence-based articles, case reports, reviewing ventilator manuals, and advice from the Intensive Care on-line Network representatives. The guidelines were reviewed by a Pediatric Intensivist and the Pediatric Respiratory Therapists then approved by the Medical Director and PICU Operations Committee. Clinical guidelines and educational opportunities were made available throughout the last 1½ years. To evaluate the guidelines effectiveness a survey was given to 44 Therapists involved in pediatric care, resulting in 29 respondents. The survey consisted of new graduates and experienced Respiratory Therapists using a Likert scale. Results: Of 29 respondents, 75% of the therapists were involved with a patient requiring APRV. Survey results reflected 65% of the participants agreed the guidelines were beneficial for initiating APRV or found the guidelines useful when making changes according to blood gases with 35% possessing a neutral response (no participants disagreed). In the past year, 55% of the survey participants felt more confident in recommending APRV if the mode of ventilation could benefit a patient (38% had a neutral response and 7% disagreed). Conclusion: APRV has proven to be a valuable mode of ventilation used for recruitment in lung injured patients. Lack of knowledge in the mode can lead to respiratory and hemodynamic instability or failure to consider using APRV. Survey findings showed APRV guidelines instituted in the PICU can be beneficial in guiding bedside ventilator management and used to educate residents and new respiratory staff. Further evaluation could be conducted simulating case scenarios to assess guideline effectiveness. Sponsored Research - None