Evaluation of an Educational Intervention in an Intensive Care Setting to Increase Staff Compliance with Using Low Tidal Volume Ventilation
Acute respiratory distress syndrome (ARDS) is a life-threatening inflammatory condition characterized by severe hypoxemia. ARDS is responsible for one in every ten admissions to the intensive care unit (ICU), with 25% of those on mechanical ventilation. Data confirm higher tidal volumes are associated with higher mortality. The use of low tidal volume ventilation (LTVV) reduces days of mechanical ventilation and decreases the incidence of ventilator-associated lung injuries. Despite the evidence, the adoption of this lung-protective strategy has been suboptimal in practice.
Education was provided to clinicians working directly with mechanical ventilation in a rural Georgia hospital. Educational tools were provided by the Agency for Healthcare Research and Quality (AHRQ). Data were collected on previous practice habits and then compared to new practice habits after the education. A retrospective chart review (RCR) was conducted to screen adults on mechanical ventilation between June and December of 2021. Inclusion criteria required a diagnosis of ARDS as outlined by the Berlin definition. Of 102 charts reviewed, 84 charts met inclusion criteria. Primary outcomes evaluated were the diagnosis of ARDS and a tidal volume ≤ 6-8 ml/kg of predicted body weight (PBW). A prospective chart review (PCR) was conducted between October and December of 2022. Of 47 charts reviewed in the PCR, 28 charts met inclusion criteria.
Prior to staff education, 41.7% of charts were compliant with LTVV guidelines. Following education, this increased to 75% compliance. An incidental finding was the decreased incidence of pneumothoraces. Prior to education, the incidence of pneumothorax was 24.5%. After education, this decreased to 0.0%. Charts with documented pneumothorax all had tidal volume settings above the recommended 6-8 ml/kg of PBW.
Implications for Practice
This quality improvement 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.