A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality
Journal of Critical Care
Purpose of the study: The purpose of the study is to determine if teleintensive care unit (ICU)-directed daily ventilator rounds improved adherence to lung protective ventilation (LPV), reduced ventilator duration ratio (VDR), and ICU mortality ratios. Method used: A retrospective observational longitudinal quarterly analysis of adherence to low tidal volume LPV (< 7.5 mL/kg predicted body weight; PaO2/fraction of inspired oxygen < 300), ventilator duration, and ICU mortality ratios (Acute Physiology and Chronic Health Evaluation IV-adjusted). The teleICU practice used Philips (Andover, MA) VISICU eCareManager (TM) (Andover, MA) platform, providing ICU care and process improvement. Results: Before ventilator rounds implementation, there was wide variation in hospital adherence to low tidal volume (29.5 +/- 18.2; range 10%-69%). Longitudinal improvement was seen across hospitals in the 3 Qs after implementation, reaching statistical significance by Q3 postimplementation (44.9 +/- 15.7; P < .002 by 2-tailed Fisher exact test), maintained at 2 subsequent Qs (48% and 52%; P < .001). Ventilator duration ratio also showed preimplementation variability (1.08 +/- .34; range 0.71-1.90). After implementation, absolute and significant mean VDR reduction was observed (0.92 +/- .28; -15.8%, P < .05). Intensive care unit mortality ratio demonstrated longitudinal improvement, reaching significance after the Q3 postimplementation (0.94 vs 0.67; P < .04), and this was sustained in the most recent Q analyzed (0.65; P < .03). Conclusions: Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality. (C) 2014 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3ol).
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