Use of mechanical ventilation protocols in intensive care units: a survey of current practice

Mechanical ventilation protocols for treating intensive care unit (ICU) patients are often recommended to improve process of care and outcomes, but their composition may be variable and penetration into clinical practice may be incomplete. We sought to ascertain ICU and hospital characteristics associated with adoption of mechanical ventilation (MV) protocols in Ontario, Canada.

We surveyed respiratory therapy leaders in all 97 Ontario hospitals capable of providing MV in an ICU.

We received responses from 70 hospitals (72.2%). Two-thirds (46/67; 68.7%) of hospitals reported having a respiratory therapist on duty 24 hours/7 days per week. Mechanical ventilation protocols were present in most hospitals (47/67; 70.2%), but low tidal volume ventilation was incorporated into only half of these protocols (24/44; 54.5%). Factors associated with reported use of MV protocols were intensivist-staffing model (89.3% vs 56.4%; odds ratio [OR], 6.44; [95% confidence interval {CI}, 1.66-25.0; P = .007]), presence of daily multidisciplinary rounds (84.4% vs 42.9%; OR, 7.24 [95% CI, 2.22-23.6; P = .001]), and presence of 24 hour/7 days per week respiratory therapist coverage (87.0% vs 36.4%; OR, 11.7 [95% CI, 3.44-39.6; P < .001]). The likelihood of having an MV protocol also increased with increasing patient-to-physician ratio (OR for each increase of 1 patient, 1.17 [95% CI, 1.01-1.35; P = .034] and increasing ICU size (OR for each additional ICU bed, 1.05 [95% CI, 1.00-1.10; P = .04]).

Most surveyed hospitals reported the presence of a protocol for MV, but only half of these incorporated low tidal volume ventilation. Several organizational factors were associated with adoption of protocols, and therefore, these should also be considered when evaluating the impact of protocols on clinical outcomes.