Quality improvement project to improve adherence to lung protective ventilation guidelines.

Abstract

Introduction: Lung protective ventilation (LPV) is advocated for all patients requiring mechanical ventilation (MV), for any duration of time, to prevent worsening lung injury. Previous studies proved simple interventions can increase awareness of LPV and disease pathophysiology as well as improve adherence to LPV guidelines.

Objective: To assess the impact of a multi-component LPV quality improvement project (QIP) on adherence to LPV guidelines.

Methods: Tidal volume data for all patients requiring MV at a large, tertiary UK critical care unit were collected retrospectively over 3, 6 months, Plan-Do-Study-Act cycles between September 2019 and August 2022. These cycles included the sequential implementation of LPV reports, bedside whiteboards and targeted education led by a multispecialty working group.

Main outcome measure: Adherence against predetermined targets of <5% of MV hours spent at >10 mL/kg predicted body weight (PBW) and >75% of MV hours spent <8 mL/kg PBW for all patients requiring MV.

Results: 408 949 hours (17 040 days) of MV data were analysed. Improved LPV adherence was demonstrated throughout the QIP. During mandated MV, time spent >10 mL/kg PBW reduced from 7.65% of MV hours to 4.04% and time spent <8 mL/kg PBW improved from 68.86% of MV hours to 71.87% following the QIP. During spontaneous MV, adherence improved with a reduction in time spent >10 mL/kg PBW from baseline to completion (13.2% vs 6.75%) with increased time spent <8 mL/kg PBW (62.74% vs 72.25%). Despite demonstrating improvements in adherence, we were unable to achieve success in all our predetermined targets.

Conclusion: This multicomponent intervention including the use of LPV reports, bedside whiteboards and education improves adherence to LPV guidelines. More robust data analysis of reasons for non-adherence to our predetermined targets is required to guide future interventions that may allow further improvement in adherence to LPV guidelines.