Feedback and education improve physician compliance in use of lung-protective mechanical ventilation

Intensive Care Med. 2005 Apr;31(4):540-6. doi: 10.1007/s00134-005-2581-9. Epub 2005 Feb 25.


Objective: Use of lung-protective mechanical ventilation (MV) by applying lower tidal volumes is recommended in patients suffering from acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Recent data suggest that lung-protective MV may benefit non-ALI/ARDS patients as well. This study analyzed tidal volume settings in three ICUs in The Netherlands to determine the effect of feedback and education concerning use of lung-protective MV.

Design and setting: Observational study in one academic and two nonacademic "closed format" ICUs.

Patients: Intubated mechanically ventilated subjects.

Interventions: Feedback and education concerning lung-protective MV with special attention to the importance of closely adjusting tidal volumes to predicted body weight (PBW).

Results: Tidal volumes declined significantly within 6 months after intervention (from 9.8+/-2.0 at baseline to 8.1+/-1.7 ml/kg PBW) as the percentage of undesirable ventilation data points, defined as tidal volumes greater than 8 ml/kg PBW (84% vs. 48%). There were no differences between patients meeting the international definition criteria for ALI/ARDS and those not. Only four patients received tidal volumes less than 6 ml/kg PBW. Lower tidal volumes were still used after 12 months. Tidal volumes in patients on mandatory MV and patients breathing on spontaneous modes were similar.

Conclusions: Feedback and education improve physician compliance in use of lung-protective MV.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Education, Continuing*
  • Feedback*
  • Female
  • Guideline Adherence*
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Practice Patterns, Physicians'*
  • Respiration, Artificial / methods*
  • Respiratory Distress Syndrome / prevention & control*
  • Respiratory Distress Syndrome / therapy
  • Tidal Volume