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Related Concept Videos

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Mechanical ventilation is a life-saving technique for managing acute respiratory failure and other respiratory complications. The process involves using a machine known as a ventilator to supply oxygen to the lungs and assist in removing carbon dioxide. It serves as a bridge to long-term mechanical ventilation or a temporary measure until ventilatory support is discontinued. The ventilator can maintain this function for a prolonged period, providing critical support for patients until they can...
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Related Experiment Video

Updated: Dec 11, 2025

Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation
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Multi-factorial barriers and facilitators to high adherence to lung-protective ventilation using a computerized

Andrew J Knighton1, Jacob Kean2, Doug Wolfe3

  • 1Implementation Science Research, Healthcare Delivery Institute, Intermountain Healthcare, 5026 South State Street, 3rd Floor, Murray, UT 84107 USA.

Implementation Science Communications
|August 25, 2020
PubMed
Summary

Lung-protective ventilation (LPV) adherence varies in ICUs despite its benefits for acute respiratory distress syndrome (ARDS) patients. Strategies like universal initiation, adherence measurement, and education can improve LPV and clinical decision support tool use.

Keywords:
Acute respiratory distress syndrome (ARDS)Barriers and facilitatorsClinical decision supportComputerized protocolImplementationMechanical ventilationMixed methods

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Area of Science:

  • Critical Care Medicine
  • Pulmonary Medicine
  • Health Services Research

Background:

  • Lung-protective ventilation (LPV) using low tidal volumes (≤ 6.5 ml/kg PBW) is crucial for acute respiratory distress syndrome (ARDS) patients.
  • Despite proven benefits, LPV adherence remains suboptimal in many intensive care units (ICUs).
  • A computerized LPV clinical decision support (CDS) tool aims to standardize LPV implementation.

Purpose of the Study:

  • To identify implementation barriers and facilitators for Lung-protective ventilation (LPV) and its associated CDS tool.
  • To understand variations in LPV adherence across different ICUs.
  • To inform a pilot hybrid implementation-effectiveness clinical trial for ARDS management.

Main Methods:

  • An explanatory sequential mixed methods study was conducted from June 2018 to March 2019.
  • Quantitative analysis of LPV adherence and CDS tool use across 17 ICUs.
  • Qualitative content analysis of 47 key informant interviews (physicians, respiratory therapists, nurses) in 3 ICUs to explore adherence variations.

Main Results:

  • Initial tidal volume ≤ 6.5 ml/kg PBW was used in 42% of patients; LPV CDS tool use was 28%.
  • Multi-factorial barriers and facilitators influenced LPV and CDS tool use, varying by ICU adherence level.
  • Key barriers included clinician attitudes, perceived loss of autonomy with CDS tools, physician-RT interaction dynamics, and lack of clear success metrics.

Conclusions:

  • Significant variation in LPV adherence persists even in early adopter healthcare systems.
  • Implementing LPV and CDS tools for ARDS patients can be enhanced by initiating low tidal ventilation universally.
  • Establishing adherence measures and targeted education on interprofessional collaboration are crucial for improving LPV use.