Feedback and education improve physician compliance in use of lung-protective mechanical ventilation.

<bold>Objective: </bold>Use of lung-protective mechanical ventilation (MV) by applying lower tidal volumes is recommended in patients suffering from acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Recent data suggest that lung-protective MV may benefit non-ALI/ARDS patients as well. This study analyzed tidal volume settings in three ICUs in The Netherlands to determine the effect of feedback and education concerning use of lung-protective MV.<bold>Design and Setting: </bold>Observational study in one academic and two nonacademic "closed format" ICUs.<bold>Patients: </bold>Intubated mechanically ventilated subjects.<bold>Interventions: </bold>Feedback and education concerning lung-protective MV with special attention to the importance of closely adjusting tidal volumes to predicted body weight (PBW).<bold>Results: </bold>Tidal volumes declined significantly within 6 months after intervention (from 9.8+/-2.0 at baseline to 8.1+/-1.7 ml/kg PBW) as the percentage of undesirable ventilation data points, defined as tidal volumes greater than 8 ml/kg PBW (84% vs. 48%). There were no differences between patients meeting the international definition criteria for ALI/ARDS and those not. Only four patients received tidal volumes less than 6 ml/kg PBW. Lower tidal volumes were still used after 12 months. Tidal volumes in patients on mandatory MV and patients breathing on spontaneous modes were similar.<bold>Conclusions: </bold>Feedback and education improve physician compliance in use of lung-protective MV. [ABSTRACT FROM AUTHOR]