Effect of a clinical decision support system on adherence to a lower tidal volume mechanical ventilation strategy

  • Eslami S
  • de Keizer N
  • Abu-Hanna A
 et al. 
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Abstract

Purpose: The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (VT) recommendations. Materials and Methods: We performed a prospective before-after evaluation study on applied VTto 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 VTrecords 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 VTgreater 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 VTin exceeding 6 mL/kg PBW and the mean percentage of ventilation time with VTgreater 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 VTrecords 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 VTmechanical ventilation strategy for patients ventilated for longer than 24 hours. © 2009 Elsevier Inc. All rights reserved.

Author-supplied keywords

  • Computerized decision support systems
  • Mechanical ventilation
  • Tidal volume
  • Ventilator-associated lung injury

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