Abstract
IntroductionEmergency department (ED) patients are frequently ventilated with excessively large tidal volumes for predicted body weight based on height, which has been linked to poorer patient outcomes. We hypothesized that supplying tape measures to respiratory therapists (RT) would improve measurement of actual patient height and adherence to a lung-protective ventilation strategy in an ED-intensive care unit (ICU) environment.MethodsOn January 14, 2019, as part of a ventilator-associated pneumonia prevention bundle in our ED-based ICU, we began providing RTs with tape measures and created a best practice advisory reminding them to record patient height. We then retrospectively collected data on patient height and tidal volumes before and after the intervention.ResultsWe evaluated 51,404 tidal volume measurements in 1,826 patients over the 4 year study period; of these patients, 1,579 (86.5%) were pre-intervention and 247 (13.5%) were post-intervention. The intervention was associated with a odds of the patient’s height being measured were 10 times higher post-intervention (25.1% vs 3.2%, P <0.05). After the bundle was initiated, we observed a significantly higher percentage of patients ventilated with mean tidal volumes less than 8 cubic centimeters per kilogram (93.9% vs 84.5% P < 0.05).ConclusionPatients in an ED-ICU environment were ventilated with a lung-protective strategy more frequently after an intervention reminding RTs to measure actual patient height and providing a tape measure to do so. A significantly higher percentage of patients had height measured rather than estimated after the intervention, allowing for more accurate determination of ideal body weight and calculation of lung-protective ventilation volumes. Measuring all mechanically ventilated patients’ height with a tape measure is an example of a simple, low-cost, scalable intervention in line with guidelines developed to improve the quality of care delivered to critically ill ED patients.
Highlights
Emergency department (ED) patients are frequently ventilated with excessively large tidal volumes for predicted body weight based on height, which has been linked to poorer patient outcomes
Patients in an ED-intensive care unit (ICU) environment were ventilated with a lung-protective strategy more frequently after an intervention reminding respiratory therapists (RT) to measure actual patient height and providing a tape measure to do so
Tidal volumes for each patient were averaged over the course of their ED-ICU stay and this average was used to determine whether lungprotective ventilation was achieved
Summary
Emergency department (ED) patients are frequently ventilated with excessively large tidal volumes for predicted body weight based on height, which has been linked to poorer patient outcomes. We hypothesized that supplying tape measures to respiratory therapists (RT) would improve measurement of actual patient height and adherence to a lung-protective ventilation strategy in an ED-intensive care unit (ICU) environment. 240,000 patients receive mechanical ventilation in US emergency departments (ED) every year.[1] these patients frequently do not receive ventilation with a lung-protective strategy as outlined by recommendations from American and European critical. Tape Measure on the Provision of Lung-protective Ventilation care societies.[2,3] An important element of a lung-protective ventilation strategy is low tidal volume ventilation.[4] Since appropriate tidal volumes are based on predicted body weight by height, accurate assessment of patient height is crucial. Therapeutic interventions started in the ED are often carried forward during the patient’s stay in the intensive care unit (ICU),[13] further highlighting the importance of starting lung-protective ventilation early
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