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

Eslami, Saeid; de Keizer, Nicolette F.; Abu-Hanna, Ameen; de Jonge, Evert; Schultz, Marcus J.

doi:10.1016/j.jcrc.2008.11.006

« Previous Next »Journal of Critical Care
Volume 24, Issue 4 , Pages 523-529, December 2009

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

Saeid Eslami, PharmD
- Department of Medical Informatics, Academic Medical Center, Universiteit van Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Corresponding author.
Nicolette F. de Keizer, PhD
- Department of Medical Informatics, Academic Medical Center, Universiteit van Amsterdam, 1105 AZ Amsterdam, The Netherlands
Ameen Abu-Hanna, PhD
- Department of Medical Informatics, Academic Medical Center, Universiteit van Amsterdam, 1105 AZ Amsterdam, The Netherlands
Evert de Jonge, MD, PhD
- Department of Intensive Care, Academic Medical Center, Universiteit van Amsterdam, 1105 AZ Amsterdam, The Netherlands
Marcus J. Schultz, MD, PhD, FCCP
- Department of Intensive Care, Academic Medical Center, Universiteit van Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Universiteit van Amsterdam, 1105 AZ Amsterdam, The Netherlands

published online 23 February 2009.

Abstract

Purpose

The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume (V_T) recommendations.

Materials and Methods

We performed a prospective before-after evaluation study on applied V_T to 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 V_T records 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 V_T greater 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 V_T in exceeding 6 mL/kg PBW and the mean percentage of ventilation time with V_T greater 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 V_T records 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 V_T mechanical ventilation strategy for patients ventilated for longer than 24 hours.

Keywords: Mechanical ventilation, Tidal volume, Ventilator-associated lung injury, Computerized decision support systems