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VOLUME 18 , ISSUE 11 ( November, 2014 ) > List of Articles


A complete audit cycle to assess adherence to a lung protective ventilation strategy

Emma Joynes, Satinder Dalay, Jaimin Patel, Samia Fayek

Keywords : Intensive care, protective, respiratory, tidal volume, ventilation

Citation Information : Joynes E, Dalay S, Patel J, Fayek S. A complete audit cycle to assess adherence to a lung protective ventilation strategy. Indian J Crit Care Med 2014; 18 (11):746-749.

DOI: 10.4103/0972-5229.144020

License: CC BY-ND 3.0

Published Online: 01-12-2008

Copyright Statement:  Copyright © 2014; The Author(s).


There is clear evidence for the use of a protective ventilation protocol in patients with acute respiratory distress syndrome (ARDS). There is evidence to suggest that protective ventilation is beneficial in patients at risk of ARDS. A protective ventilation strategy was implemented on our intensive care unit in critical care patients who required mechanical ventilation for over 48 h, with and at risk for ARDS. A complete audit cycle was performed over 13 months to assess compliance with a safe ventilation protocol in intensive care. The ARDS network mechanical ventilation protocol was used as the standard for our protective ventilation strategy. This recommends ventilation with a tidal volume (Vt ) of 6 ml/kg of ideal body weight (IBW) and plateau airway pressure of ≤30 cm H 2 O. The initial audit failed to meet this standard with Vt ′s of 9.5 ml/kg of IBW. Following the implementation of a ventilation strategy and an educational program, we demonstrate a significant improvement in practice with Vt ′s of 6.6 ml/kg of IBW in the re-audit. This highlights the importance of simple interventions and continuous education in maintaining high standards of care.

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  1. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network. N Engl J Med 2000;342:1301-8.
  2. Slutsky AS. Consensus conference on mechanical ventilation - January 28-30, 1993 at Northbrook, Illinois, USA. Part 2. Intensive Care Med 1994;20:150-62.
  3. Pelosi P, Negrini D. Extracellular matrix and mechanical ventilation in healthy lungs: Back to baro/volotrauma? Curr Opin Crit Care 2008;14:16-21.
  4. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med 2013;369:428-37.
  5. Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 2004;32:1817-24.
  6. Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med 2005;31:922-6.
  7. Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, et al. Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: A preventive randomized controlled trial. Crit Care 2010;14:R1.
  8. Schultz MJ, Haitsma JJ, Slutsky AS, Gajic O. What tidal volumes should be used in patients without acute lung injury? Anesthesiology 2007;106:1226-31.
  9. Pinheiro de Oliveira R, Hetzel MP, dos Anjos Silva M, Dallegrave D, Friedman G. Mechanical ventilation with high tidal volume induces inflammation in patients without lung disease. Crit Care 2010;14:R39.
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