Respiratory Therapist-Driven Mechanical Ventilation Protocol Is Associated With Increased Lung Protective Ventilation

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Respiratory Therapy

Background:

• Mechanical ventilation is essential but carries risks like ARDS and oxygen toxicity.
• Nonadherence to lung-protective ventilation guidelines is a significant clinical challenge.
• Developing strategies to improve adherence is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the impact of a respiratory therapist-driven mechanical ventilation bundle.
• To determine if the protocol increases adherence to lung-protective ventilation.
• To assess the effect on pulmonary complication rates in the ICU.

Main Methods:

• Implementation of a respiratory therapist-driven protocol in adult ICUs starting August 1, 2018.
• Protocol focused on low tidal volume, adequate PEEP, limited oxygen, appropriate breathing frequency, and head elevation.
• Retrospective analysis of adherence and clinical outcomes for ventilated patients (≥24 hours) from January 2011 to December 2019.

Main Results:

• Significant increase in adherence to lung-protective ventilation post-intervention (aOR 2.48).
• Reduced incidence of Acute Respiratory Distress Syndrome (ARDS) in the post-intervention group (aOR 0.22).
• No significant differences observed in VAP, ventilator-free days, or ICU/30-day mortality.

Conclusions:

• A respiratory therapist-driven protocol effectively enhances adherence to lung-protective mechanical ventilation.
• The protocol is associated with a significant decrease in ARDS incidence among ICU patients.
• This intervention represents a valuable strategy for improving mechanical ventilation safety.