Increasing Compliance with Low-Tidal-Volume Ventilation in Patients with ARDS:

Nearly 37 % of all critically ill patients do not receive commonly recommended best practices (Ilan et al., 2007). It has been 13 years since the Acute Respiratory Distress Syndrome (ARDS) Network published its landmark, multi-center, randomized controlled trial demonstrating that use of low-tidal-volume ventilation (LTVV) (defined as a tidal volume [VT] of 6 mL/kg predicted body weight [PBW]) was associated with a 9% decrease in mortality compared to traditional approaches to mechanical ventilation (10 to 15 mL/kg PBW) (Brower, Matthay, Schoenfeld, Thompson, & Wheeler, 2000). Needham et al. (2012) reported that each milliliter above 6 mL/kg PBW increased mortality by nearly 20 % over a two-year period. However, LTVV has not been widely adopted into clinical practice. There is considerable evidence that among ICUs nationwide, up to 70 % of patients with ARDS do not consistently receive LTVV, resulting in an estimated 5,465 preventable deaths each year (Pronovost et al., 2004). Dennison, Mendez-Tellez, Wang, Pronovost, and Needham (2007) have suggested barriers included lack of knowledge, diagnostic uncertainty, error calculating appropriate tidal volume, unspecified protocol, communication failures, and concern with patient discomfort. Adherence to LTVV is unacceptably low at Johns Hopkins Hospital (JHH). Needham et al. (2012) reported that among ARDS patients recruited from four academic hospitals in Baltimore, which included JHH and Bayview Medical Center, 86 % received ≤50 % of their ventilator settings adherent to LTVV. Furthermore, 37 % never received LTVV at all. Thus, increasing adherence to a lung protective ventilation (LPV) strategy is an important quality improvement (QI)opportunity. We therefore undertook a QI project to increase adherence to LTVV in patients with ARDS. The aim of this project was to determine whether an educational and teamwork program could improve adherence with the recommended LPV strategy. Methods ARDSNet (2012). ARDSNet protocol ventilator settings reference card. Retrieved fro