Related Experiment Video
Updated: Mar 31, 2026
Evaluating Regional Pulmonary Deposition using Patient-Specific 3D Printed Lung Models
Published on: November 11, 2020
ICU Implementation Determinants and Delivery of Lung Protective Ventilation: A Multihospital Survey and Cohort Study
Chad H Hochberg1, Sophia A Emetu1, Kevin J Psoter1
1Division of Pulmonary and Critical Care Medicine (C. H. H., S. K. S., T. J. I., D. N. H., and M. N. E.), Department of Medicine (S. A. E.), Department of Pediatrics (K. J. P.), the Bloomberg School of Public Health (T. J. I.), Johns Hopkins University, Baltimore, MD; and the Pulmonary, Allergy and Critical Care Division (M. P. K.), Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Background:
Lung protective ventilation (LPV) improves mortality in patients with ARDS and is applied widely in other patients receiving mechanical ventilation. Despite strong evidence, LPV is implemented inconsistently.
Research Question:
Are staff-rated ICU implementation determinants associated with delivery of patient-level LPV delivery.
Study Design And Methods:
We conducted a cross-sectional survey of ICU clinical staff (January-June 2024) and a retrospective study of patients with hypoxemic respiratory failure receiving mechanical ventilation (January 2023-December 2024). We assessed staff-rated implementation determinants using validated surveys including domains for implementation culture (eg, team cooperation), staff stress, and available resources. We assessed the association of ICU-level survey scores with patient-level LPV (defined as tidal volume [VT] ≤ 6.5 mL/kg of perdicted body weight (PBW) and plateau pressure ≤ 30 cm H2O), and, as a complementary secondary outcome, hours spent at VT > 8 mL/kg PBW on day 1 of mechanical ventilation. We used mixed-effects negative binomial models including LPV hours as the outcome, eligible time as an offset, patient and ICU covariates, and a random effect for ICU.
Results:
Survey measures from 469 ICU staff (50% response rate) were incorporated into the cohort of 2,120 patients across 5 hospitals and 14 ICUs. Median percentage compliance with LPV on day 1 was 68% (interquartile range, 0%-100%). A 1-SD increase in ICU implementation culture score was not associated with LPV (adjusted rate ratio [aRR], 1.04 [95% CI, 0.95-1.14]; P = .37), but was associated with less time at VT > 8 mL/kg PBW (aRR, 0.48 [95% CI, 0.32-0.71]; P < .01). Increased staff stress was not associated with time at LPV (aRR, 0.98 [95% CI, 0.89-1.07]; P = .62), but was associated with more time at VT > 8 mL/kg (aRR, 1.71 [95% CI, 1.19-2.45]; P < .01). Results for ICU resources were: aRR of 1.02 (95% CI, 0.88-1.17; P = .83) for LPV and aRR of 0.36 (95% CI, 0.20-0.64; P < .01) for VT > 8 mL/kg PBW.
Interpretation:
In this multihospital study, ICU implementation determinants were associated with receiving VT >8 mL/kg PBW, but not with a stricter LPV definition. These findings may inform development of interventions to enhance ICU implementation determinants and improve LPV delivery.
Related Concept Videos
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:29Mechanical Ventilation I: Indication and Settings
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management