Reduction in tidal volumes for ventilated patients

Published Date: 10th August 2016

Publication Authors: Fuller A,

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Introductions

Over 60 % of patients admitted to an Intensive Care Unit (ICU) will require Endotracheal Tube (ETT) intubation and mechanical ventilation. The aim was to perform an audit of ventilation regimes in critically ill patients admitted to Whiston Hospital. Its main objectives were to evaluate the current management of ventilated patients on ICU at Whiston hospital in comparison to the current local standards of best practice, with the main emphasis surrounding IBW (Ideal Body Weight) documentation and reduction in initial tidal volume (TV) from traditional guidelines.

Methods

A retrospective study looking at a sample cohort of 182 patients admitted to the ICU at Whiston from January 2014 to the end of June 2014 who was managed with either Pressure Regulated Volume Control (PRVC) or Synchronised Intermittent Mandatory Ventilation (SIMV). Of those 182 candidates, 107 matched the ventilation inclusion criteria. The data sources used were under the ICU subcategory on the trust electronic data management system and ICU electronic charting system. A data collection proforma was completed for each patient.

Results

All patients initiated on PRVC or SIMV should have their anthropometric measurement of ulnar length or actual height recorded. It was found only 35.5 % of patients admitted had these recorded as opposed to the local guideline of 100 %. 50 % had documented IBW with 16.9 % of those not having a recorded optimal TV based on 6 ml/kg. Of the 45 patients who had documented IBW appropriate TV calculated, 62 % were commenced on TV greater than their calculated optimal TV. Every patient’s arterial oxygen saturations were to be maintained between 88-92 %. Only 10.3 % of patients met this standard, although 95.4 % of patients maintained saturations greater than 88 %.

Conclusions

To summarise it is clear that documentation relating to ventilation care is lacking despite a clear section outlined on the ICU admission proforma. A proposal to resolve this issue would be to use a laminated sheet including patient’s ulnar length/actual height, IBW and optimal TV. 

Fuller, A; McLindon, P; Sim, K. (2016). A reduction in tidal volumes for ventilated patients on ICU calculated from IBW. can it minimise mortality in comparison to traditional strategies?​ . Critical Care. 20 (Suppl 2), 99-100

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