How to achieve adherence to a ventilation algorithm for critically ill children?

Ventilation Practitioner Anita Duyndam publiceerde het onderstaande onderzoek.  

ABSTRACT

Aims and objectives

To evaluate to what extent physicians on a paediatric intensive care unit (PICU) adhered to a newly implemented ventilation algorithm.

Background

PICUs worldwide use different ventilators with a wide variety of ventilation modes. We developed an algorithm, as part of a larger protocol, for choice of ventilation mode at time of admission.

Design

This study was performed in a level III PICU of a university children's hospital and had an uncontrolled, pre-post test design with a period before implementation (T0) and two periods after implementation (T1 and T2).

Methods

An invasive ventilation algorithm targeted at two patient groups was implemented in October 2008. The algorithm distinguished between lung disease, in which pressure control was considered as the preferred mode, and no lung disease, in which pressure-regulated volume control was preferred. Nurses and physicians were instructed in the use of the algorithm before implementation.

Results

During three test periods, a total of 507 children with a median age of 5 months [interquartile range (IQR) 0–50] on conventional invasive mechanical ventilation were included. In patients with lung disease, pre-implementation adherence rate was 79% (67/85). At T1 it was 71% (51/72); at T2 84% (46/55). The slight improvement from T1 to T2 was statistically not significant (p = 0·092). In patients with no lung disease, the adherence rate rose statistically significantly from 66% at T0 (62/93) to 78% (79/101) at T1, and 84% at T2 (85/101) (p = 0·015).

Conclusion

Implementation of a new ventilation algorithm increased physicians' adherence to this ventilation algorithm and the effect was sustained over time. This was achieved by education, reminders and organizational changes such as admission of postcardiac surgery patients with protocolized nursing care including preset ventilator settings.

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