A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality

作者：Kalb Thomas^*; Raikhelkar Jayashree; Meyer Shelley; Ntimba Francis; Thuli Jason; Gorman Mary Jo; Kopec Isabelle; Scurlock Corey

来源：Journal of Critical Care, 2014, 29(4): 691.e7.

DOI：10.1016/j.jcrc.2014.02.017

• Telemedicine
• TeleICU
• Mechanical ventilation
• Low tidal volume strategy
• Lung protective ventilation
• Ventilation duration ratio
• ICU mortality ratio

Purpose of the study: The purpose of the study is to determine if teleintensive care unit (ICU)-directed daily ventilator rounds improved adherence to lung protective ventilation (LPV), reduced ventilator duration ratio (VDR), and ICU mortality ratios.
Method used: A retrospective observational longitudinal quarterly analysis of adherence to low tidal volume LPV (< 7.5 mL/kg predicted body weight; PaO2/fraction of inspired oxygen < 300), ventilator duration, and ICU mortality ratios (Acute Physiology and Chronic Health Evaluation IV-adjusted). The teleICU practice used Philips (Andover, MA) VISICU eCareManager (TM) (Andover, MA) platform, providing ICU care and process improvement.
Results: Before ventilator rounds implementation, there was wide variation in hospital adherence to low tidal volume (29.5 +/- 18.2; range 10%-69%). Longitudinal improvement was seen across hospitals in the 3 Qs after implementation, reaching statistical significance by Q3 postimplementation (44.9 +/- 15.7; P < .002 by 2-tailed Fisher exact test), maintained at 2 subsequent Qs (48% and 52%; P < .001). Ventilator duration ratio also showed preimplementation variability (1.08 +/- .34; range 0.71-1.90). After implementation, absolute and significant mean VDR reduction was observed (0.92 +/- .28; -15.8%, P < .05). Intensive care unit mortality ratio demonstrated longitudinal improvement, reaching significance after the Q3 postimplementation (0.94 vs 0.67; P < .04), and this was sustained in the most recent Q analyzed (0.65; P < .03).
Conclusions: Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality.

• 出版日期2014-8