Effect of a clinical decision support system on adherence to a lower tidal volume mechanical ventilation strategy

Abstract

Purpose The purpose of the study was to measure the effect of a computerized decision support system (CDSS) on adherence to tidal volume ( V T) recommendations. Materials and Methods We performed a prospective before-after evaluation study on applied V T to examine the impact of a CDSS on adherence to our local protocol in a 30-bed mixed medical-surgical intensive care unit of a university hospital. All intensive care unit patients who were intubated and mechanically ventilated for at least 1 hour were included. Results A total of 3 663 674 V T records of 696 patients were analyzed. The average volume greater than 6 mL/kg predicted body weight (PBW) and the mean percentage of ventilation time with V T greater than 6 mL/kg PBW decreased after intervention by 6.0% and 3.4%, respectively (not significant). A stronger effect of the decision support intervention was found among patients with longer duration of mechanical ventilation (>24 hours): for these patients, the average V T in exceeding 6 mL/kg PBW and the mean percentage of ventilation time with V T greater than 6 mL/kg PBW decreased after intervention by 18.3% ( P = .01) and 9.5% ( P = .01), respectively. In this group, the mean percentage of ventilation time with V T records between 8 and 10, between 10 and 12, and greater than 12 mL/kg PBW decreased by 21.8% ( P = .006), 21.5% ( P = .047), and 24.7% ( P = .155), respectively. Conclusions The use of a CDSS, integrated in a patient data management system, improves implementation of a lower V T mechanical ventilation strategy for patients ventilated for longer than 24 hours.