TY - JOUR
T1 - Organizational factors associated with adherence to low tidal volume ventilation
T2 - a secondary analysis of the CHECKLIST-ICU database
AU - CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet)
AU - Midega, Thais Dias
AU - Bozza, Fernando A.
AU - Machado, Flávia Ribeiro
AU - Guimarães, Helio Penna
AU - Salluh, Jorge I.
AU - Nassar, Antonio Paulo
AU - Normílio-Silva, Karina
AU - Schultz, Marcus J.
AU - Cavalcanti, Alexandre Biasi
AU - Serpa Neto, Ary
AU - Neto, Pedro Aniceto Nunes
AU - Fernandes, Carlos Alberto
AU - Luchesi, Cristiano Ávila
AU - de Sa, Natalia Rodrigues
AU - Rodrigues, Roberta Antunes Faria
AU - Radespiel, Larissa Stefany
AU - dos Santos Iorio, Vinicius Leonardo
AU - Bhering, Danielle
AU - Linhares, Viviane Ribeiro
AU - Westphal, Glauco Adrieno
AU - Sperotto, Geonice
AU - da Silva Rossi, Soraya Byana Rezende
AU - Ferreira, Thaismari Escarmanhani
AU - de Brito Sobrinho, Edgar
AU - Reis, Helder Jose Lima
AU - Carneiro, Mauricio Soares
AU - de Oliveira Lameira Veríssimo, Adriana
AU - Fernandes, Juliana Fernandez
AU - Ferreira, Rodrigo Lopes
AU - Pinho, Sylvania Campos
AU - Dultra, Leonardo
AU - Hizumi, Lise Oliveira
AU - de Lima, Neiva Fernandes
AU - da Silva, Alexsandra Raimunda
AU - dos Santos, Liliane
AU - Vaz, Sidiner Mesquita
AU - Oliveira, José Marcio
AU - Laviola, Miria Bonjour
AU - de Freitas, Wania Vasconcelos
AU - Passos, Leonardo
AU - Rabello, Ligia Sarmet Cunha Farah
AU - de Siqueira, Carollina Resende
AU - de Oliveira Silva, Luiz Carlos
AU - Junior, Francisco Felix Barreto
AU - Cruz, Eduarda Maria Alves
AU - Malbouisson, Luiz Marcelo Sa
AU - Caltabeloti, Fabiola Prior
AU - Bassi, Estevão
AU - da Silva, Patrícia Regiane
AU - de Carvalho Filho, Marco Antonio
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Background: Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV.Methods: Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV.Results: The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV.Conclusions: Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients.
AB - Background: Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV.Methods: Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV.Results: The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV.Conclusions: Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients.
KW - Intensive care unit
KW - Invasive ventilation, lung protection
KW - Organizational factors
KW - Tidal volume, low tidal volume ventilation
UR - http://www.scopus.com/inward/record.url?scp=85085976135&partnerID=8YFLogxK
U2 - 10.1186/s13613-020-00687-3
DO - 10.1186/s13613-020-00687-3
M3 - Article
AN - SCOPUS:85085976135
SN - 2110-5820
VL - 10
JO - Annals of Intensive Care
JF - Annals of Intensive Care
M1 - 68
ER -