A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality

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• 作者：Thomas Kalb ; MD^a ; ^b ; ^{Tkalb@icumedicine.com" class="auth_mail} ; Jayashree Raikhelkar ; MD^b ; Shelley Meyer ; RN^b ; Francis Ntimba ; MD^b ; Jason Thuli ; BA^b ; Mary Jo Gorman ; MD ; MBA^b ; Isabelle Kopec ; MD^b ; Corey Scurlock ; MD ; MBA^b
• 关键词：Telemedicine ; TeleICU ; Mechanical ventilation ; Low tidal volume strategy ; Lung protective ventilation ; Ventilation duration ratio ; ICU mortality ratio
• 刊名：Journal of Critical Care
• 出版年：August 2014
• 年：2014
• 卷：29
• 期：4
• 页码：691.e7-691.e14
• 全文大小：593 K

文摘

The purpose of the study is to determine if teleintensive care unit (ICU)-directed daily ventilator rounds improved adherence to lung protective ventilation (LPV), reduced ventilator duration ratio (VDR), and ICU mortality ratios.

bsSec_2">Method used

A retrospective observational longitudinal quarterly analysis of adherence to low tidal volume LPV (< 7.5 mL/kg predicted body weight; Paob>2b>/fraction of inspired oxygen < 300), ventilator duration, and ICU mortality ratios (Acute Physiology and Chronic Health Evaluation IV–adjusted). The teleICU practice used Philips (Andover, MA) VISICU eCareManager^TM (Andover, MA) platform, providing ICU care and process improvement.

bsSec_3">Results

Before ventilator rounds implementation, there was wide variation in hospital adherence to low tidal volume (29.5 ± 18.2; range 10%-69%). Longitudinal improvement was seen across hospitals in the 3 Qs after implementation, reaching statistical significance by Q3 postimplementation (44.9 ± 15.7; P < .002 by 2-tailed Fisher exact test), maintained at 2 subsequent Qs (48% and 52%; P < .001). Ventilator duration ratio also showed preimplementation variability (1.08 ± .34; range 0.71-1.90). After implementation, absolute and significant mean VDR reduction was observed (0.92 ± .28; − 15.8%, P < .05). Intensive care unit mortality ratio demonstrated longitudinal improvement, reaching significance after the Q3 postimplementation (0.94 vs 0.67; P < .04), and this was sustained in the most recent Q analyzed (0.65; P < .03).

bsSec_4">Conclusions

Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality.