![]() If the patient does not require a lot of oxygen, starting at 0.50 and weaning within a few minutes to target SpO 2 >92% is ideal. If on high oxygen, start FiO 2 at 1.00 and then wean to SpO 2. FiO 2įiO 2 is mandatory to set and should be titrated based on what the patient needed before non-invasive application. These settings will be discussed in detail below. IPAP pressure (delta Pressure, similar to pressure support).Therefore, the settings to be set for NIV are: First, you will set the oxygen delivery (FiO 2), a distending pressure to help recruit alveoli (EPAP), and a high pressure to augment the patient’s normal breath (IPAP). The back-up setting is a basic RR (remember, this setting does not replace the patient spontaneously breathing). There are three main settings that need to be adjusted as well as one additional “back-up” setting. Initiating non-invasive ventilation is very similar to how you approach setting up PSV for a spontaneously breathing patient. Based on the positive outcomes of this pilot study, an additional study is warranted to determine if a mandated staff education will increase compliance with LTVV when compared to a non-mandated staff education.Initiation and Titration of NIV/BiPAP Settings This quality improvement project suggests an elective educational intervention for ICU staff improves compliance with LTVV use. Charts with documented pneumothorax all had tidal volume settings above the recommended 6-8 ml/kg of PBW. Prior to education, the incidence of pneumothorax was 24.5%. An incidental finding was the decreased incidence of pneumothoraces. Following education, this increased to 75% compliance. Prior to staff education, 41.7% of charts were compliant with LTVV guidelines. Of 47 charts reviewed in the PCR, 28 charts met inclusion criteria. A prospective chart review (PCR) was conducted between October and December of 2022. Primary outcomes evaluated were the diagnosis of ARDS and a tidal volume ≤ 6-8 ml/kg of predicted body weight (PBW). Of 102 charts reviewed, 84 charts met inclusion criteria. Inclusion criteria required a diagnosis of ARDS as outlined by the Berlin definition. A retrospective chart review (RCR) was conducted to screen adults on mechanical ventilation between June and December of 2021. Data were collected on previous practice habits and then compared to new practice habits after the education. Educational tools were provided by the Agency for Healthcare Research and Quality (AHRQ). ![]() Despite the evidence, the adoption of this lung-protective strategy has been suboptimal in practice.Įducation was provided to clinicians working directly with mechanical ventilation in a rural Georgia hospital. The use of low tidal volume ventilation (LTVV) reduces days of mechanical ventilation and decreases the incidence of ventilator-associated lung injuries. Data confirm higher tidal volumes are associated with higher mortality. ARDS is responsible for one in every ten admissions to the intensive care unit (ICU), with 25% of those on mechanical ventilation. Evaluation of an Educational Intervention in an Intensive Care Setting to Increase Staff Compliance with Using Low Tidal Volume VentilationĪcute respiratory distress syndrome (ARDS) is a life-threatening inflammatory condition characterized by severe hypoxemia.
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