Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Abstract

Background. Considerable discrepancies have been observed in the implementation of strategies to liberate patients from mechanical ventilation. The aim of this study was to describe critical care nurses' knowledge of and self-reported and documented adherence to lung-protective ventilation, daily sedation interruption, and daily assessment of readiness to extubate and evaluate how these practices differ between patients with and without ventilator-associated pneumonia and between survivors and nonsurvivors. Methods. The survey was conducted in a tertiary-level hospital in Finland from October 2014 to June 2015. Actual adherence was evaluated based on documentation of performed practices. Results. A total of 86 critical care nurses responded to the survey, and 85 patients were followed. The levels of knowledge of and self-reported adherence to low tidal ventilation were 84.5% and 90.2%, respectively, and the median tidal volume was at a target level in 74.4% of patients. Regarding daily sedation interruption, the level of knowledge was 85.7% and the level of self-reported adherence was 77.3% while documented adherence was 33.3%. The levels of knowledge and self-reported adherence regarding spontaneous breathing trial were 61.9% and 71.6%, respectively. Adherence to lungprotective ventilation, daily sedation interruption, and daily assessment of readiness to extubate did not differ between patients with (n=20) and without (n=65) ventilator-associated pneumonia and between survivors (n=55) and nonsurvivors (n=30). Conclusions. Lung-protective ventilation, including low-tidal ventilation and avoidance of high inspiratory plateau pressures, was well implemented and adhered to. The levels of knowledge and self-reported adherence versus documented adherence regarding daily sedation interruption and spontaneous breathing trial demonstrated insufficient implementation of local guidelines. There was no affect on the outcome.