An audit into compliance with lung protective ventilation strategies in a UK District General Hospital
Barry, J. Mooney, J. Aslam, M.
Barry, J.
Mooney, J.
Aslam, M.
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Affiliation
George Eliot Hospital NHS Trust, Nuneaton
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Publication date
2023-10-24
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Abstract
Conference abstract 000941 of the European Society of Intensive Care Medicine 36th Annual Congress, ESICM LIVES 2023, 21-25 October 2023, Milan, Italy.
Introduction: Ventilator-induced lung injury (VILI) is a complication of mechanical ventilation that can cause acute lung injury due to volutrauma, barotrauma, and harmful inflammatory processes (1). Protective lung ventilation (PLV), involves giving low tidal volumes (6-8 ml/kg) to patients and is a recommended strategy to help prevent VILI, especially in the context of acute respiratory distress syndrome (ARDS) & COVID-19 (2,3). It is therefore the standard of care that patients should receive PLV in Intensive Care Units (ICU).
Objectives: This retrospective study evaluated the compliance with PLV, as a standard of care, in George Eliot Hospital’s ICU in Nuneaton, UK from November 2022 to January 2023. Patient data was analysed to determine if there were complications of mechanical ventilation during or after their ITU stay, and whether there is any association between the incidence of these complications, and the administration of PLV.
Methods: Data was collated for 30 patients who received mechanical ventilation during the aforementioned timeframe, analysing the daily range of tidal volumes they received, and assessing the incidence and severity of complications following extubation and further care. Patients were considered to be on PLV for a given day, if the range of tidal volumes was within the PLV parameters for their ideal body weight. PLV was defined as 6-8 ml/kg of ideal body weight.
Results: 54% of the patients received tidal volumes within PLV boundaries on at least one day during their time spent on mechanical ventilation. Of the patients that received PLV, 16% received PLV for over half the time they were mechanically ventilated. Complications were seen in patients who both did and did not receive PLV, and included acute kidney injury, cardiomyopathy, pleural effusion, and delirium, both during and after admission to ICU.
Of the patients that did not receive PLV, 60% of them had chest x-rays in the days following extubation, each of which showed new pathology, including atelectatic changes, bibasal collapse, consolidation, airspace shadowing, and effusion. Of the patients who received PLV, 67% had chest x-rays in the days following extubation, all of which demonstrated new pathology.
Of the patients that didn’t receive PLV, 40% were discharged, 40% are still current inpatients, or have been transferred to different hospitals, and 20% are deceased. Of the patients that did receive PLV, on at least one day during the time they were receiving mechanical ventilation, 67% have been discharged, 16.5% are still inpatients or have been transferred to another hospital, and 16.5% are deceased.
Conclusions: Our findings show that most patients received tidal volumes outside the recommended range for PLV, potentially leading to adverse outcomes including lung volume loss, acute kidney injury, cardiomyopathy, and pleural effusion, both during and after admission. These results highlight the importance of adhering to PLV strategies to reduce the risk of VILI and associated complications.
References
1. Katira B. H. (2019). Ventilator-Induced Lung Injury: Classic and Novel Concepts. Respiratory care, 64(6), 629–637. doi: https://doi.org/10.4187/respcare.07055
2. Acute Respiratory Distress Syndrome Network, Brower, R. G., Matthay, M. A., Morris, A., Schoenfeld, D., Thompson, B. T., & Wheeler, A. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The New England journal of medicine, 342(18), 1301–1308
3. Mega, C., Cavalli, I., Ranieri, V. M., & Tonetti, T. (2022). Protective ventilation in patients with acute respiratory distress syndrome related to COVID-19: always, sometimes or never?. Current opinion in critical care, 28(1), 51–56
Citation
Barry J, Mooney J, Aslam M. An audit into compliance with lung protective ventilation strategies in a UK District General Hospital. Intensive Care Med Exp. 2023 Oct 24;11(Suppl 1):430. doi: 10.1186/s40635-023-00546-y.
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Conference Output