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993 Implementation of Ventilation Policy in a Picu
  1. A Duyndam,
  2. B van Driel,
  3. RJ Houmes,
  4. D Tibboel,
  5. E Ista
  1. Intensive Care Kinderen, Erasmus MC - Sophia Childrens Hospital, Rotterdam, The Netherlands

Abstract

Background and Aims Pediatric intensive care units (PICU) worldwide use different ventilators with a wide variety of ventilation modes. As an unambiguous international ventilation guideline, we developed one. After implementation we evaluated to what extent physicians adhered to the new guideline.

Method We developed a ventilation guideline accounting for two groups: 1) heterogeneous lung disease, in which pressure control is the preferred mode; 2) homogeneous lung disease, in which pressure-regulated volume control is preferred. The guideline was implemented in October 2008. We performed an uncontrolled, retrospective before-after design with a pre-test from January to July 2008 (T0) and two post-tests: May-November 2009 (T1); May-November 2010 (T2). All patients on conventional invasive mechanical ventilation during these periods were included. Outcome measure was the percentage of physicians’ adherence to the ventilation protocol. We measured this by describing the ventilation mode on the first hour on the day of admission and the cause of respiratory failure, to distinguish in which group this patient belonged.

Results In group 1, the T0 adherence percentage was 79% (67/85). Adherence percentages after implementation of the guideline were 71% (51/72) and 84% (46/55) for respectively T1 and T2. For group 1, adherence in period T2 was slightly better (p=0.092) than that in period T1. In group 2, adherence percentages rose statistically significantly from 66% at T0 (62/93) to 78% (79/101) and 84% (85/101) (p=0.015).

Conclusion Implementation of a new ventilation guideline increased guideline adherence over time. Selection of the appropriate ventilation mode seems now clearer for physicians.

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