Impact of a Respiratory Therapist-Initiated Lung Protective Ventilation Strategy

Background:

Low tidal volume targeted ventilation (LTVV) has been recommended as a standard strategy for adult mechanically ventilated patients and is associated with reduced mortality. Adoption of LTVV has been reported to range between 19% – 75%. All cause hospital mortality for adult mechanically ventilated patients has been reported at 28%. We sought to evaluate how a respiratory therapist directed LTVV model applied at the onset of mechanical ventilation would compare to previously reported LTVV practices. We also compared all cause hospital mortality.

Methods:

This IRB approved retrospective analysis included electronic medical record review of adult mechanically ventilated (MV) patients managed between March 2018 and March 2019. 1,425 subjects required MV for > 24 hours. The primary outcome was the percentage of subjects receiving set V_T < 8 mL/kg of predicted body weight at onset of MV when compared to a reported average of 75%. Secondary outcome was all cause hospital mortality compared to a reported average of 28%. Categorical data is reported as frequency (%) and continuous data is reported as median (IQR). Chi-Square goodness-of-fit test was applied to compare outcomes. Alpha (2-tailed) < .05.

Results:

At initiation of MV, V_T was < 8 mL/kg in 96.8% of subjects when compared to reported average of 75% (P < .001). Median V_T at initiation of MV was 6.0 mL/kg (IQR 5.9-6.3) whereas median V_T for the duration of all days of MV was 5.9 mL/kg (IQR 5.8-6.0). All cause hospital mortality was significantly lower among our subjects (18.4%) when compared to previously reported values (28%; P < .001). Median age was 61 y (60% male). Cardiac (32%), Medical (21%), and Surgical (12%) subjects accounted for the majority of the cohort. Refer to Table for additional descriptive characteristics.

Conclusions:

A respiratory therapist-directed LTVV strategy initiated at the onset of adult MV resulted in high adherence when compared to previous publications. The overall mortality observed in these subjects was significantly less than previously reported.

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