PDF(Pubmed)
Abstract：
BACKGROUND: Mechanical ventilation is a common life-saving procedure but can lead to serious complications, including ARDS and oxygen toxicity. Nonadherence to lung-protective ventilation guidelines is common. We hypothesized that a respiratory therapist-driven mechanical ventilation bundle could increase adherence to lung-protective ventilation and decrease the incidence of pulmonary complications in the ICU.
METHODS: A respiratory therapist-driven protocol was implemented on August 1, 2018, in all adult ICUs of a Midwestern academic tertiary center. The protocol targeted low tidal volume, adequate PEEP, limiting oxygen, adequate breathing frequency, and head of the bed elevation. Adherence to lung-protective guidelines and clinical outcomes were retrospectively observed in adult subjects admitted to the ICU and on ventilation for ≥ 24 h between January 2011 and December 2019.
RESULTS: We included 666 subjects; 68.5% were in the pre-intervention group and 31.5% were in the post-intervention group. After adjusting for body mass index and intubation indication, a significant increase in overall adherence to lung-protective ventilation guidelines was observed in the post-intervention period (adjusted odds ratio 2.48, 95% CI 1.73-3.56). Fewer subjects were diagnosed with ARDS in the post-intervention group (adjusted odds ratio 0.22, 95% CI 0.08-0.65) than in the pre-intervention group. There was no difference in the incidence of ventilator-associated pneumonia, ventilator-free days, ICU mortality, or death within 1 month of ICU discharge.
CONCLUSIONS: A respiratory therapist-driven protocol increased adherence to lung-protective mechanical ventilation guidelines in the ICU and was associated with decreased ARDS incidence.
METHODS: A respiratory therapist-driven protocol was implemented on August 1, 2018, in all adult ICUs of a Midwestern academic tertiary center. The protocol targeted low tidal volume, adequate PEEP, limiting oxygen, adequate breathing frequency, and head of the bed elevation. Adherence to lung-protective guidelines and clinical outcomes were retrospectively observed in adult subjects admitted to the ICU and on ventilation for ≥ 24 h between January 2011 and December 2019.
RESULTS: We included 666 subjects; 68.5% were in the pre-intervention group and 31.5% were in the post-intervention group. After adjusting for body mass index and intubation indication, a significant increase in overall adherence to lung-protective ventilation guidelines was observed in the post-intervention period (adjusted odds ratio 2.48, 95% CI 1.73-3.56). Fewer subjects were diagnosed with ARDS in the post-intervention group (adjusted odds ratio 0.22, 95% CI 0.08-0.65) than in the pre-intervention group. There was no difference in the incidence of ventilator-associated pneumonia, ventilator-free days, ICU mortality, or death within 1 month of ICU discharge.
CONCLUSIONS: A respiratory therapist-driven protocol increased adherence to lung-protective mechanical ventilation guidelines in the ICU and was associated with decreased ARDS incidence.
摘要：
背景：机械通气是一种常见的挽救生命的程序，但可能导致严重的并发症，包括ARDS和氧毒性。不遵守肺保护性通气指南是常见的。我们假设呼吸治疗师驱动的机械通气束可以提高ICU对肺保护性通气的依从性并降低肺部并发症的发生率。
方法：2018年8月1日，在中西部学术三级中心的所有成人ICU中实施了呼吸治疗师驱动的方案。协议针对低潮气量，足够的PEEP,限制氧气,充足的呼吸频率,和床头标高。回顾性观察了2011年1月至2019年12月期间入住ICU和通气≥24小时的成年受试者对肺保护指南的依从性和临床结果。
结果：我们纳入了666名受试者；干预前68.5%，干预后31.5%。调整体重指数和插管指征后，在干预后观察到肺保护性通气指南的总体依从性显著提高(校正比值比2.48,95%CI1.73~3.56).与干预前相比，干预后诊断为ARDS的受试者较少（调整后比值比0.22，95％CI0.08-0.65）。呼吸机相关性肺炎的发生率无差异,无呼吸机日，ICU死亡率，或在ICU出院后1个月内死亡。
结论：呼吸治疗师驱动的方案提高了ICU对肺保护性机械通气指南的依从性，并与ARDS发病率降低相关。
方法：2018年8月1日，在中西部学术三级中心的所有成人ICU中实施了呼吸治疗师驱动的方案。协议针对低潮气量，足够的PEEP,限制氧气,充足的呼吸频率,和床头标高。回顾性观察了2011年1月至2019年12月期间入住ICU和通气≥24小时的成年受试者对肺保护指南的依从性和临床结果。
结果：我们纳入了666名受试者；干预前68.5%，干预后31.5%。调整体重指数和插管指征后，在干预后观察到肺保护性通气指南的总体依从性显著提高(校正比值比2.48,95%CI1.73~3.56).与干预前相比，干预后诊断为ARDS的受试者较少（调整后比值比0.22，95％CI0.08-0.65）。呼吸机相关性肺炎的发生率无差异,无呼吸机日，ICU死亡率，或在ICU出院后1个月内死亡。
结论：呼吸治疗师驱动的方案提高了ICU对肺保护性机械通气指南的依从性，并与ARDS发病率降低相关。
