Acute respiratory failure requiring mechanical ventilation affects approximately one million Americans annually and is associated with mortality as high as 30% among patients admitted to intensive care units (ICUs). Low tidal volume ventilation is one treatment that has been proven effective in reducing mortality among a subset of patients with acute respiratory distress syndrome (ARDS), and may also benefit patients who undergo mechanical ventilation without ARDS. International studies have demonstrated that many patients with ARDS, up to 80% of patients in some centers, do not receive low tidal volumes. Multiple studies have demonstrated that under-recognition of ARDS and lack of or erroneous knowledge about low tidal volume ventilation are the major barriers to providing this evidence-based treatment to patients with ARDS. Across UPHS ICUs, adherence to low tidal volume ventilation is highly variable, revealing an opportunity for improvement in care quality and potentially patient outcomes. To implement simple, scalable EHR-based strategies designed to “nudge” (that is, facilitate without restricting autonomy to choose an alternative) clinicians toward low tidal volumes, in order to improve evidence-based care of patients with ARDS.
National Institutes of Health, National Heart, Lung, and Blood Institute