![]() ![]() Rectal cancer services - is it time for specialization within units? (2023).Tagged with 2020, COVID-19, Gold open access, Intensive and critical care, Respiratory care Limitations include that no consideration was made for overall patient outcome, and only a snapshot of achieved TVs from ventilators were recorded daily/weekly trends were not studied. This directly led to improved adherence to lung protective ventilation and optimisation of patient care. In a time when clinicians were being redeployed to support ICU, this simple tool was shown to support staff by clearly calculating and displaying IBW and target TV for reference. In some instances, documented IBW was vastly different to the calculated IBW, suggesting that in these situations actual body weight may have been used. Conclusion(s): This audit cycle revealed that initially adherence to lung protective ventilation and documentation of IBW was poor. ![]() Moreover, nine patients were achieving TVs within 4-6 ml/kg, with only one patient found to be achieving a TV greater than 6 ml/kg. This revealed that all patients had an IBW clearly documented. The follow-up audit included ten patients. Eleven patients were achieving a TV greater than 6 ml/kg, with two of these achieving a TV of greater than 8 ml/kg. Only three patients were achieving TVs of 4-6 ml/kg. Three patients had documented IBWs that were 12 kg, 15 kg and 23 kg greater than the weight calculated using the tool, leading to increased tidal volume targets. Six patients did not have an IBW documented. Result(s): The initial audit included 14 patients. Data was extracted from patient notes, charts and ventilator settings. All patients receiving mechanical ventilation, except those spontaneously breathing, were included. The first was conducted prior to the tool's introduction with the second two weeks after its implementation. Two snapshot audits were carried out in April and May 2020 at two ICUs. Staff received training on how to apply the tool. IBW was subsequently used to calculate a target TV. This tool was designed to use height to calculate IBW and, if the patient's height was unavailable, could also be utilised to calculate height from ulna length. To achieve TVs no greater than 6 ml/kg Methods: A 'tidal volume calculator' tool was developed using Microsoft Excel, which was simple, colour coded and kept on all Intensive Care Unit (ICU) computer desktops. ![]() To improve documentation of IBW and target TV 3. To achieve accurate calculations for ideal body weight (IBW) and target TV 2. Objective(s): As a result of the audit, three main areas for improvement were identified. A multi-centre preliminary audit was undertaken to identify whether ventilated COVID-19 related ARDS patients were receiving optimal TVs, as recommended by the Faculty of Intensive Care Medicine (FICM) and Intensive Care Society (ICS) ARDS management guidelines. Severe COVID-19 pneumonia has been associated with the development of ARDS as characterised by the Berlin definition. Introduction: Routine use of lower tidal volumes (TVs) for the mechanical ventilation of patients with ARDS results in decreased mortality and increases the number of days without ventilator use. Intensive Care Medicine Experimental 2020 vol. ![]()
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