GAMUT Metric Implementation Improves Ventilator Documentation and Management Practices

Abstract

Background

It is well established that lung-protective ventilation strategies are imperative for reducing patient morbidity and mortality. Recognizing the importance of early lung-protective ventilation in the pre-hospital setting, the Ground and Air Medical qUality Transport (GAMUT) Quality Improvement Collaborative recently established a metric that aims to keep plateau pressure < 30 mmHg. GAMUT develops and tracks transport-specific quality metrics used by both domestic and international critical care transport (CCT) programs. The impact of GAMUT metric implementation on documentation practices and patient care in a CCT program remains unanswered.

Objectives

To determine if incorporation of the GAMUT metric, plateau pressure < 30 mmHg, changed the incidence of plateau pressure documentation or lung-protective ventilation.

Methods

This was a single center, retrospective cohort study of endotracheally intubated and mechanically ventilated adult patients transported by a university affiliated, physician/nurse-staffed CCT program between August 2021 and October 2022. Patients mechanically ventilated via an extraglottic airway and those under the age of 18 were excluded. Pre-GAMUT data was collected from August 2021 to January 2022 and post-GAMUT implementation data from May 2022 to October 2022. February 2022 to April 2022 was excluded from analysis as this was the initial education and implementation period. Data was extracted from the transport service chart by a trained data abstractor and recorded in an external database (REDCap). Statistical analysis was performed using a Pearson chi square for categorical variables and a two-sample t-test for continuous variables.

Results

Before implementation of the GAMUT metric, plateau pressure was documented in 11.8% of charts (n=22/187) compared to 69.4% (n=109/157) in post GAMUT charts (p < 0.0125). There was a statistically significant increase in the proportion of patients ventilated with both plateau pressure < 30 mmHg and driving pressure < 15 mmHg post GAMUT metric implementation (p < 0.0125 for both).

Conclusions

Our findings indicate that GAMUT metric implementation not only improved documentation of plateau pressure by nearly 6-fold, but also significantly increased the proportion of patients transported with lung-protective ventilation as evidenced by both lower plateau and driving pressures. Implementation of a GAMUT metric appears to improve both documentation practices and quality of patient care.