Driving pressure during routine ventilation in the ICU: Is the ICU-team as driven as they should be?

To evaluate the effect of structured staff training on the respiratory support provided.

Staff training with emphasis on the applied DP in mechanical ventilation was provided during one year. After completion of staff training, the effect was prospectively evaluated in patients who were continuously mechanically ventilated in a controlled mode for at least 6 h starting from admission. Pressure difference (P_diff = P_peak - PEEP_tot) in the baseline period, as a derivative of the driving pressure, was compared with two evaluation periods from 0 to 6 months and 6-12 months (i.e. follow-up) after completion of the training.

At analysis 248 patients met the inclusion criteria. In the baseline period P_diff was not lung protective (> 15 cm H2O) in 39% of cases. In the first follow-up period this decreased to 25% of cases and further dropped to 17% in the second follow-up period. This was a relative decrease of 56% compared to the training period. At the end of evaluation the proportion of patients with a safe P_diff had gradually increased from 58% during training to 82% (χ² = p 0.005).

These results suggest that ICU staff training could lead to more adequate respiratory support provided during controlled mechanical ventilation.