Document Detail

Limiting ventilator-induced lung injury through individual electronic medical record surveillance.
MedLine Citation:
PMID:  20959788     Owner:  NLM     Status:  In-Process    
BACKGROUND: To improve the safety of ventilator care and decrease the risk of ventilator-induced lung injury, we designed and tested an electronic algorithm that incorporates patient characteristics and ventilator settings, allowing near-real-time notification of bedside providers about potentially injurious ventilator settings.
METHODS: Electronic medical records of consecutive patients who received invasive ventilation were screened in three Mayo Clinic Rochester intensive care units. The computer system alerted bedside providers via the text paging notification about potentially injurious ventilator settings. Alert criteria included a Pao2/Fio2 ratio of <300 mm Hg, free text search for the words "edema" or "bilateral + infiltrates" on the chest radiograph report, a tidal volume of >8 mL/kg predicted body weight (based on patient gender and height), a plateau pressure of >30 cm H2O, and a peak airway pressure of >35 cm H2O. Respiratory therapists answered a brief online satisfaction survey. Ventilator-induced lung injury risk was compared before and after the introduction of ventilator-induced lung injury alert.
FINDINGS: The prevalence of acute lung injury was 42% (n = 490) among 1,159 patients receiving >24 hrs of invasive ventilation. The system sent 111 alerts for 80 patients, with a positive predictive value of 59%. The exposure to potentially injurious ventilation decreased after the intervention from 40.6 ± 74.6 hrs to 26.9 ± 77.3 hrs (p = .004).
INTERPRETATIONS: Electronic medical record surveillance of mechanically ventilated patients accurately detects potentially injurious ventilator settings and is able to influence bedside practice at moderate costs. Its implementation is associated with decreased patient exposure to potentially injurious mechanical ventilation settings.
Vitaly Herasevich; Mykola Tsapenko; Marija Kojicic; Adil Ahmed; Rachul Kashyap; Chakradhar Venkata; Khurram Shahjehan; Sweta J Thakur; Brian W Pickering; Jiajie Zhang; Rolf D Hubmayr; Ognjen Gajic
Related Documents :
8294628 - Pressure support ventilation via face mask in acute respiratory failure in hypercapnic ...
17125638 - Pulmonary edema and lung injury after severe laryngospasm.
10980738 - Pressure-controlled ventilation via a mini-tracheostomy tube for patients with neuromus...
7010098 - Severe lung oedema and fatal consumption coagulopathy after funnel-web bite.
22316078 - Clinical review: humidifiers during non-invasive ventilation--key topics and practical ...
3367008 - Cocaine and cardiovascular function in dogs: effects on heart and peripheral circulation.
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  34-9     Citation Subset:  AIM; IM    
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, and Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic College of Medicine, Rochester, MN, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Grant Support
Comment In:
Crit Care Med. 2011 Jan;39(1):196-7   [PMID:  21178533 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Extracorporeal membrane oxygenation for pediatric respiratory failure: Survival and predictors of mo...
Next Document:  Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated wi...