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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2020

Open Access 01-12-2020 | Acute Respiratory Distress-Syndrome | Research

Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database

Authors: Thais Dias Midega, Fernando A. Bozza, Flávia Ribeiro Machado, Helio Penna Guimarães, Jorge I. Salluh, Antonio Paulo Nassar Jr., Karina Normílio-Silva, Marcus J. Schultz, Alexandre Biasi Cavalcanti, Ary Serpa Neto, for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet)

Published in: Annals of Intensive Care | Issue 1/2020

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Abstract

Background

Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV.

Methods

Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV.

Results

The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV.

Conclusions

Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients.
Appendix
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Metadata
Title
Organizational factors associated with adherence to low tidal volume ventilation: a secondary analysis of the CHECKLIST-ICU database
Authors
Thais Dias Midega
Fernando A. Bozza
Flávia Ribeiro Machado
Helio Penna Guimarães
Jorge I. Salluh
Antonio Paulo Nassar Jr.
Karina Normílio-Silva
Marcus J. Schultz
Alexandre Biasi Cavalcanti
Ary Serpa Neto
for the CHECKLIST-ICU Investigators and the Brazilian Research in Intensive Care Network (BRICNet)
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-00687-3

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