PDF(Pubmed)
Abstract：
BACKGROUND: Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for this care. The objectives of this 2019-2020 community-based quality improvement project were to: a) identify patients at greater risk of not receiving LPV, and b) evaluate the effectiveness of a series of brief quality improvement educational sessions to improve LPV setting protocol adherence rates.
METHODS: A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients\' heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions.
RESULTS: Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01).
CONCLUSIONS: Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders.
METHODS: A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients\' heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions.
RESULTS: Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01).
CONCLUSIONS: Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders.
摘要：
背景：在急诊科（ED）需要气管插管和机械通气的患者病情危重，他们的呼吸机管理对他们随后的临床结局至关重要.肺保护性通气（LPV）设置策略是这种护理的关键考虑因素。这个2019-2020年基于社区的质量改进项目的目标是：a）确定未接受LPV风险更大的患者，和b）评估一系列简短的质量改进教育会议的有效性，以提高LPV设置协议的依从率。
方法：在进行一系列10-15分钟的教育课程之前和之后，对呼吸机设置和受试者特征（N=200）进行了15个月的回顾性图表审查，以提高LPV依从性。此信息已在一系列的四次教育会议上提供，分别针对25位主治医生（n=两次会议）和27位会议居民（n=两次会议）。两种附加材料(例如，LPV参考图表，测量患者身高的卷尺）也张贴在三个ED复苏室和装有紧急气道设备的机柜上。在教育课程之前和之后，对LPV设置顺序的干预前后发生率进行了推理比较。
结果：使用LPV通气的患者在接受教育后从70％增加到82％（p=0.04）。所有身高67英寸或更高的患者在治疗前后都进行了适当的通气。对于身高65英寸以下的患者，术后LPV依从性从13%增加到53%(p=0.01).
结论：基于这些结果，简短的ED提供者教育干预可以显着提高基于LPV指南的设置的利用率.身高65英寸以下的患者也可能特别有接受非LPV呼吸机设置命令的风险。
方法：在进行一系列10-15分钟的教育课程之前和之后，对呼吸机设置和受试者特征（N=200）进行了15个月的回顾性图表审查，以提高LPV依从性。此信息已在一系列的四次教育会议上提供，分别针对25位主治医生（n=两次会议）和27位会议居民（n=两次会议）。两种附加材料(例如，LPV参考图表，测量患者身高的卷尺）也张贴在三个ED复苏室和装有紧急气道设备的机柜上。在教育课程之前和之后，对LPV设置顺序的干预前后发生率进行了推理比较。
结果：使用LPV通气的患者在接受教育后从70％增加到82％（p=0.04）。所有身高67英寸或更高的患者在治疗前后都进行了适当的通气。对于身高65英寸以下的患者，术后LPV依从性从13%增加到53%(p=0.01).
结论：基于这些结果，简短的ED提供者教育干预可以显着提高基于LPV指南的设置的利用率.身高65英寸以下的患者也可能特别有接受非LPV呼吸机设置命令的风险。
