Impact of ICU Staffing Models on Tidal Volume in Acute Lung Injury Patients
Author Information
Author(s): Colin R Cooke, Timothy R Watkins, Jeremy M Kahn, Miriam M Treggiari, Ellen Caldwell, Leonard D Hudson, Gordon D Rubenfeld
Primary Institution: University of Washington School of Medicine
Hypothesis
Closed model ICUs would recognize patients with ALI more frequently and deliver lower tidal volumes compared to open model ICUs.
Conclusion
Patients with ALI in closed model ICUs are more likely to receive lower tidal volumes and less likely to receive higher tidal volumes, but this does not explain the improved mortality in these units.
Supporting Evidence
- Patients in closed ICUs were more likely to receive lower tidal volumes (≤ 6.5 mL/Kg PBW).
- Patients in closed ICUs were less likely to receive potentially injurious tidal volumes (≥ 12 mL/Kg PBW).
- Plateau pressure was measured more often in closed model ICUs.
Takeaway
Patients in closed ICUs get smaller breaths when they are on a ventilator, which is better for their lungs, but this doesn't fully explain why they do better overall.
Methodology
Secondary analysis of a prospective cohort study involving 759 patients with ALI from 23 ICUs.
Potential Biases
Potential misclassification of ICU staffing models and residual confounding may affect results.
Limitations
The study was conducted before the ARDSNet study established lower tidal volume ventilation as a standard, and some variables affecting ventilator settings were not available.
Participant Demographics
Patients included were predominantly older adults, with a mean age of 66 years in open ICUs and 57 years in closed ICUs.
Statistical Information
P-Value
p < 0.001
Confidence Interval
95% CI = 0.57 to 2.24 mL/Kg PBW
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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