Evaluation of an Educational Intervention in an Intensive Care Setting to Increase Staff Compliance with Using Low Tidal Volume Ventilation

Carol Lynne Van Buul



ARDS is a life-threatening inflammatory condition characterized by severe hypoxemia. ARDS is responsible for one in 10 admissions to ICU, with 25% on mechanical ventilation. The mortality rate for severe ARDS is 46%. Data confirm higher tidal volumes are associated with higher mortality. LTVV reduces days of mechanical ventilation and decreases the incidence of ventilator-associated lung injury. The mean cost of caring for patients with ARDS ranges between $8,475 and $47,974 per hospital stay. Despite the evidence supporting LTVV, its use has been suboptimal in practice. The aim is to increase staff compliance with LTVV use, improve knowledge, and compare practice habits before and after an educational intervention.


Education was provided to clinicians working directly with mechanical ventilation in a rural community hospital in Georgia. The education included a PowerPoint and the Daily LTVV Data Collection Tool provided by the AHRQ. Data were collected on previous practice habits and compared to new practice habits after an intervention. An RCR was conducted to screen adults on mechanical ventilation between June 2021 and December of 2021. Inclusion criteria required a diagnosis of ARDS as outlined by the Berlin definition. Of the 102 charts reviewed, 84 patients met the inclusion criteria. The primary outcomes evaluated were the diagnosis of ARDS and the use of a tidal volume of ≤ 6ml/kg of PBW. The secondary outcome was for patients at risk for ARDS and a tidal volume of ≤8ml/kg of PBW. The PCR was conducted between October 2022 and December 2022. For the PCR, 47 charts were reviewed and of those, 28 charts met the inclusion criteria. Also reviewed was the incidence of pneumothorax.


The RCR resulted in 41.7% compliance with LTVV guidelines. Following implementation, this increased to 75% compliance. An unexpected finding was the reduction of pneumothoraces. Prior to implementation, the incidence of pneumothorax was 14.3%. After implementation, this decreased to 0.0%. Of all pneumothoraces, 100% were above the recommended setting.


This project suggests an elective educational intervention for ICU staff improves compliance with LTVV use. Based on the positive outcomes of this pilot study, an additional study is warranted to determine if a mandated staff education will increase compliance with LTVV when compared to a non-mandated staff education. This suggestion is based on the unexpected, favorable outcome of a significant reduction of lung injuries associated with higher tidal volumes. Future work is needed to develop interventions using adjunct strategies and recruitment maneuvers in addition to LTVV for the management of severe respiratory failure in patients with ARDS.