Achieving Targeted Tidal Volumes Through Lean Process Improvement

Abstract

PURPOSE: The literature supports specific targeted tidal volumes (Vt) based on ideal body weight (IBW) to improve mortality outcomes in patients with ARDS, and this trend has extended to ventilated patients in general. Institutional baseline measures indicated only 6% of ventilated patients had Vt set to IBW at 6 ml/kg. METHODS: A lean process improvement team investigated current practice and collected several key data points: demographics, recorded height, measured height, and set Vt. A review of the data revealed inconsistencies between recorded and measured height contributing to inaccurate Vt. A standard process was implemented to obtain height via direct measurement of each patient upon ICU admission. That measurement was then used by the respiratory therapist (RT) to identify the patient's corresponding targeted Vt while on assist control ventilation. Discrepancies between ordered Vt and targeted Vt were communicated to the attending physician for review. To facilitate this process, each room was equipped with a disposable tape measure and laminated chart of IBW and Vt. RESULTS: At 30 days post implementation, the percentage of ventilated patients with targeted Vt at ICU admission improved from 6% to 39%. Upon discussion between RT and physician, the number of patients with targeted Vt increased to 52%. At 60 days, 53% had targeted Vt at ICU admission; after discussion between RT and physician, the number of patients with targeted Vt increased to 79%. CONCLUSIONS: Standardizing the process by which height is recorded led to an increase in the number of patients receiving targeted Vt settings based on IBW.