Document Detail


Limiting ventilator-induced lung injury through individual electronic medical record surveillance.
MedLine Citation:
PMID:  20959788     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
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.
Authors:
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
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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    
Affiliation:
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. herasevich.vitaly@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Grant Support
ID/Acronym/Agency:
1 KL2 RR024151/RR/NCRR NIH HHS; K23 HL78743-01A1/HL/NHLBI NIH HHS; KL2 RR024151/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
Crit Care Med. 2011 Jan;39(1):196-7   [PMID:  21178533 ]

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