Feedback and education improve physician compliance in use of lung-protective mechanical ventilation

Objective: Use of lung-protective mechanical ventilation (MV) by applying lower tidal volumes is recommended in patients suffering from acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Recent data suggest that lung-protective MV may benefit non-ALI/ARDS patients as well. This study analyzed tidal volume settings in three ICUs in The Netherlands to determine the effect of feedback and education concerning use of lung-protective MV. Design and setting: Observational study in one academic and two nonacademic "closed format" ICUs. Patients: Intubated mechanically ventilated subjects. Interventions: Feedback and education concerning lung-protective MV with special attention to the importance of closely adjusting tidal volumes to predicted body weight (PBW). Results: Tidal volumes declined significantly within 6 months after intervention (from 9.8 +/- 2.0 at baseline to 8.1 +/- 1.7 ml/kg PBW) as the percentage of undesirable ventilation data points, defined as tidal volumes greater than 8 ml/kg PBW (84% vs. 48%). There were no differences between patients meeting the international definition criteria for ALI/ARDS and those not. Only four patients received tidal volumes less than 6 ml/kg PBW. Lower tidal volumes were still used after 12 months. Tidal volumes in patients on mandatory MV and patients breathing on spontaneous modes were similar. Conclusions: Feedback and education improve physician compliance in use of lung-protective MV.