Improving Compliance with Lung Protective Ventilation: Modification of Default Ventilator Settings is More Effective than Clinical Decision Support
Postoperative acute lung injury may be reduced by the utilization of intraoperative lung protective ventilation including lowered intraoperative tidal volumes and the use of positive end expiratory pressure (PEEP). While lung protective ventilation strategies are being increasingly adopted, compliance remains imperfect. We implemented three sequential interventions and studied their impact on compliance with lung protective ventilation. First, a computerized clinical decision support system (CDSS) tool was created to identified patients at high risk for acute lung injury using the surgical lung injury prediction (SLIP) model and communicate personalized ventilator settings to schedule anesthesia providers a day prior to surgery. Second, a real-time system was implemented to identify these patients and to identify high tidal volume ventilation. Finally, default ventilator settings were modified. Data were analyzed using mean tidal volumes and mean use of PEEP within surgical cases per week to assess trend outcomes of each intervention. Preliminary results show that, over the span of 77 weeks, each intervention irregularly but gradually delivers increased lung protective ventilation across 54,517 surgical cases. Pre-intervention, 69.58% of cases utilized PEEP with an average median tidal volume of 472 mL. Following default ventilator setting modifications, 74.88% of cases utilized PEEP with an average median tidal volume of 439 mL. Moving forward, available data will be analyzed via segmented regression to elucidate additional trends. In all, the sequential interventions were each effective in improving compliance with lung protective ventilation, with the modification of the default ventilator settings having the largest effect.