TY - JOUR
T1 - Effect of a clinical decision support system on adherence to a lower tidal volume mechanical ventilation strategy
AU - Eslami, Saeid
AU - de Keizer, Nicolette F.
AU - Abu-Hanna, Ameen
AU - de Jonge, Evert
AU - Schultz, Marcus J.
PY - 2009
Y1 - 2009
N2 - PURPOSE: The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (V(T)) recommendations. MATERIALS AND METHODS: We performed a prospective before-after evaluation study on applied V(T) to examine the impact of a CDSS on adherence to our local protocol in a 30-bed mixed medical-surgical intensive care unit of a university hospital. All intensive care unit patients who were intubated and mechanically ventilated for at least 1 hour were included. RESULTS: A total of 3 663 674 V(T) records of 696 patients were analyzed. The average volume greater than 6 mL/kg predicted body weight (PBW) and the mean percentage of ventilation time with V(T) greater than 6 mL/kg PBW decreased after intervention by 6.0% and 3.4%, respectively (not significant). A stronger effect of the decision support intervention was found among patients with longer duration of mechanical ventilation (>24 hours): for these patients, the average V(T) in exceeding 6 mL/kg PBW and the mean percentage of ventilation time with V(T) greater than 6 mL/kg PBW decreased after intervention by 18.3% (P = .01) and 9.5% (P = .01), respectively. In this group, the mean percentage of ventilation time with V(T) records between 8 and 10, between 10 and 12, and greater than 12 mL/kg PBW decreased by 21.8% (P = .006), 21.5% (P = .047), and 24.7% (P = .155), respectively. CONCLUSIONS: The use of a CDSS, integrated in a patient data management system, improves implementation of a lower V(T) mechanical ventilation strategy for patients ventilated for longer than 24 hours
AB - PURPOSE: The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (V(T)) recommendations. MATERIALS AND METHODS: We performed a prospective before-after evaluation study on applied V(T) to examine the impact of a CDSS on adherence to our local protocol in a 30-bed mixed medical-surgical intensive care unit of a university hospital. All intensive care unit patients who were intubated and mechanically ventilated for at least 1 hour were included. RESULTS: A total of 3 663 674 V(T) records of 696 patients were analyzed. The average volume greater than 6 mL/kg predicted body weight (PBW) and the mean percentage of ventilation time with V(T) greater than 6 mL/kg PBW decreased after intervention by 6.0% and 3.4%, respectively (not significant). A stronger effect of the decision support intervention was found among patients with longer duration of mechanical ventilation (>24 hours): for these patients, the average V(T) in exceeding 6 mL/kg PBW and the mean percentage of ventilation time with V(T) greater than 6 mL/kg PBW decreased after intervention by 18.3% (P = .01) and 9.5% (P = .01), respectively. In this group, the mean percentage of ventilation time with V(T) records between 8 and 10, between 10 and 12, and greater than 12 mL/kg PBW decreased by 21.8% (P = .006), 21.5% (P = .047), and 24.7% (P = .155), respectively. CONCLUSIONS: The use of a CDSS, integrated in a patient data management system, improves implementation of a lower V(T) mechanical ventilation strategy for patients ventilated for longer than 24 hours
U2 - https://doi.org/10.1016/j.jcrc.2008.11.006
DO - https://doi.org/10.1016/j.jcrc.2008.11.006
M3 - Article
C2 - 19327326
SN - 0883-9441
VL - 24
SP - 523
EP - 529
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 4
ER -