A Critical Care Clinician Survey Comparing Attitudes and Perceived Barriers to Low Tidal Volume Ventilation with Actual Practice

Abstract

Clinicians had positive attitudes toward low-Vt ventilation and perceived few barriers to using it, but attitudes and perceived process barriers were not correlated with actual low-Vt ventilation use, which was low. Implementation strategies should be focused on examining other issues, such as ARDS recognition and process solutions, to improve low-Vt ventilation use.

Simulation-Based Evaluation of Mechanical Ventilators

“…We know that even the simple, evidence-based, lung-protective strategies are practiced by a minority of clinicians. 26,27 In one survey, more than one third of all patients with ARDS received a tidal volume of Ͼ 8 mL/kg predicted body weight, and ϳ60% received a tidal volume of Ͼ 7 mL/kg. 28 This is alarming, given that one study estimated that an increase of 1 mL/kg in initial tidal volume was associated with a 23% increase in ICU mortality risk.…”

Multi-factorial Barriers and Facilitators to High Adherence to Lung Protective Ventilation Using a Computerized Protocol: A Mixed Methods Study

“…This becomes important as COVID-19 patients in the ICU are experiencing high rates of ARDS and are likely to benefit from LPV. [36] Consistent with earlier studies, [11] physicians and RTs statements that LPV strategies were most appropriate for patients with ARDS and indicated that they were consistently ordered and that an initial LTVV was used were not consistent with the provisional adherence data. This attitude-behavior gap [37] between intent and actual practice is consistent with earlier studies demonstrating that clinician beliefs and perceived barriers to using LPV were not correlated with LPV initiation.…”

“…This attitude-behavior gap [37] between intent and actual practice is consistent with earlier studies demonstrating that clinician beliefs and perceived barriers to using LPV were not correlated with LPV initiation. [11,14] Several factors may begin to explain this gap. Efforts to promote adherence continued between the time when we generated provisional measurement data and when field interviews were conducted.…”

“…[2] General agreement exists among physicians, respiratory therapists (RTs) and nurses that LPV is warranted for patients with ARDS, although studies demonstrate a substantial divide between belief and actual practice. [11] Identified barriers to the use of LPV include physician ability to recognize ARDS in a timely fashion [12,13]; lack of written protocols [14,15]; lack of concordance with clinician perceptions of patient needs [11,12,14]; and perceptions by nurses and RTs that LTVV is more labor-intensive and that present staffing is inadequate to achieve full adherence. [11,14] Intermountain Healthcare (Intermountain) was involved in early ARDS network studies [5] and demonstrated high adherence at one hospital site but system-wide adherence was not attained.…”

Ecological Validity in the Critical Care Environment: Closing the Loop on Evidence Based Medicine

“…Implementation of basic guideline recommendations for ARDS care remains poor despite positive physician attitudes toward their utility. 13,14 Implementing new protocols is a cumbersome and costly process, requiring educational…”