Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database
Abstract Background Survival benefit from low tidal volume (V T) 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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-06-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00687-3 |
| _version_ | 1819290549550579712 |
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| author | Thais Dias Midega Fernando A. Bozza Flávia Ribeiro Machado Helio Penna Guimarães Jorge I. Salluh Antonio Paulo Nassar Karina Normílio-Silva Marcus J. Schultz Alexandre Biasi Cavalcanti Ary Serpa Neto for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet) |
| author_facet | Thais Dias Midega Fernando A. Bozza Flávia Ribeiro Machado Helio Penna Guimarães Jorge I. Salluh Antonio Paulo Nassar Karina Normílio-Silva Marcus J. Schultz Alexandre Biasi Cavalcanti Ary Serpa Neto for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet) |
| author_sort | Thais Dias Midega |
| collection | DOAJ |
| description | Abstract Background Survival benefit from low tidal volume (V T) 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 V T ≤ 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. |
| first_indexed | 2024-12-24T03:24:31Z |
| format | Article |
| id | doaj.art-64f58213a86e4c89a2459110434bdfe1 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-24T03:24:31Z |
| publishDate | 2020-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-64f58213a86e4c89a2459110434bdfe12022-12-21T17:17:23ZengSpringerOpenAnnals of Intensive Care2110-58202020-06-0110111010.1186/s13613-020-00687-3Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU databaseThais Dias Midega0Fernando A. Bozza1Flávia Ribeiro Machado2Helio Penna Guimarães3Jorge I. Salluh4Antonio Paulo Nassar5Karina Normílio-Silva6Marcus J. Schultz7Alexandre Biasi Cavalcanti8Ary Serpa Neto9for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet)Department of Critical Care Medicine, Hospital Israelita Albert EinsteinResearch Institute, Instituto D’Or de Pesquisa e Ensino (IDOR)Anesthesiology, Pain and Intensive Care Department, Federal University of São PauloDepartment of Critical Care Medicine, Hospital Israelita Albert EinsteinGraduate Program in Translational Medicine and Department of Critical Care, Instituto D’Or de Pesquisa e Ensino (IDOR)Intensive Care Unit and Postgraduate Program, A.C. Camargo Cancer CenterResearch Institute, HCor-Hospital do CoraçãoDepartment of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical CenterResearch Institute, HCor-Hospital do CoraçãoDepartment of Critical Care Medicine, Hospital Israelita Albert EinsteinAbstract Background Survival benefit from low tidal volume (V T) 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 V T ≤ 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.http://link.springer.com/article/10.1186/s13613-020-00687-3Intensive care unitInvasive ventilation, lung protectionTidal volume, low tidal volume ventilationOrganizational factors |
| spellingShingle | Thais Dias Midega Fernando A. Bozza Flávia Ribeiro Machado Helio Penna Guimarães Jorge I. Salluh Antonio Paulo Nassar Karina Normílio-Silva Marcus J. Schultz Alexandre Biasi Cavalcanti Ary Serpa Neto for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet) Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database Annals of Intensive Care Intensive care unit Invasive ventilation, lung protection Tidal volume, low tidal volume ventilation Organizational factors |
| title | Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database |
| title_full | Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database |
| title_fullStr | Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database |
| title_full_unstemmed | Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database |
| title_short | Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database |
| title_sort | organizational factors associated with adherence to low tidal volume ventilation a secondary analysis of the checklist icu database |
| topic | Intensive care unit Invasive ventilation, lung protection Tidal volume, low tidal volume ventilation Organizational factors |
| url | http://link.springer.com/article/10.1186/s13613-020-00687-3 |
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