Persistent use of lower tidal volumes after a simple intervention consisting of feedback and education

Introduction

Use of lower tidal volumes (Vt) is recommended for patients suffering from ALI/ARDS. We previously reported on a simple 'intervention' aimed at lowering Vt (goal: Vt 6–8 ml/kg): this intervention consisted of feedback and education on the use of lower Vt, during which special attention was paid to the importance of closely adjusting Vt to predicted body weight (PBW) instead of actual body weight. This intervention resulted in a significant decline of Vt in our IC [1].

Methods

To determine the longstanding effects of the aforementioned intervention: (a) we compared data on Vt before feedback and education (June 2003, n = 50, period I) with Vt 15 months later (September 2004, n = 103, period III); (b) in addition, we collected data on Vt of patients recruited in two consecutive randomized controlled ALI/ARDS trials: the first trial was performed in the 10-month period before the intervention (March 2002–December 2002, n = 12), and the second was performed in a 10-month period after the intervention (July 2003–May 2004, n = 8).

Statistical analysis

Mann–Whitney test. P < 0.05 was considered significant.

Results

(a) Before intervention, Vt was 9.4 (IQR: 8.2–10.8) ml/kg PBW; Vt declined shortly after the intervention and remained low (7.7 [6.9–8.5] ml/kg PBW) 15 months after the intervention (Fig. 1a); (b) Vt in the second randomized controlled trial was significantly lower as compared with Vt in the first study on ALI/ARDS patients (Fig. 1b).

Figure 1

(abstract P97)

Conclusions

Feedback and education caused a persistent decline in Vt in our IC. These results possibly underscore the use of PBW, instead of actual body weight, to adjust Vt.