None listed
Conditions
Brief summary
A small number of patients who are brought to the emergency department need a general anaesthetic. This lets us help them by keeping their airway open, improve their oxygen levels and breathe for them on a mechanical ventilator. Some of these patients have injured or severely diseased lungs. In these patients, a protective ventilator setting (small volumes of breath at lower pressures) reduces rates of death and time on a ventilator. Other patients have normal lungs initially, but are at risk of developing lung disease whilst on a ventilator. The use of the same protective ventilator settings on these patients can reduce the development of severe lung disease, including infections and lung collapse. Currently, the ventilator settings in our emergency department are set by the bedside, treating clinician. These may not always be with protective settings. We aim to improve the quality of our care of our ventilated patients by optimising ventilator settings and increasing the frequency by which protective settings are used. This will be done by implementing a guideline (called ELVIS) designed to prompt clinicians and bed-side nursing staff to set the ventilator to patient-specific, protective values whilst promoting frequent reassessment of these targets and adjusting settings on a regular basis to meet the patients needs. This guideline has been developed by both Intensive Care and Emergency Medicine specialists. The ELVIS guideline will be used on all ventilated patients in the emergency department, unless the clinician believes an alternate method is safer based on their underlying lung disease. For example, asthmatic patients do not need a protective strategy and will not have the guideline used. Most ventilated patients are transferred from the emergency department to the intensive care unit. These protective ventilator settings will be continued in intensive care. This study aims to compare clinical data, ventilation settings and outcomes of patients ventilated according to the ELVIS guideline to those who were ventilated during the subsequent two years (2015-2016).
Interventions
The Emergency Lung-protective Ventilation Implementation Strategy guideline aims to standardise the mechanical ventilation of intubated Emergency Department patients in a metropolitan tertiary referral hospital. The guideline encourages accurate calculation of 'ideal body weight' (IBW) through measurement of patient height & aims to ventilate patients at 6-8mL/kg of IBW, whilst maintaining a plateau pressure of less than 30cmH2O. It also mandates prescribed ventilation & oxygenation targets empo
The Emergency Lung-protective Ventilation Implementation Strategy guideline aims to standardise the mechanical ventilation of intubated Emergency Department patients in a metropolitan tertiary referral hospital. The guideline encourages accurate calculation of 'ideal body weight' (IBW) through measurement of patient height & aims to ventilate patients at 6-8mL/kg of IBW, whilst maintaining a plateau pressure of less than 30cmH2O. It also mandates prescribed ventilation & oxygenation targets empowering bedside nursing staff to adjust ventilator settings or seek early medical assistance in providing finessed, patient-specific, lung-protective ventilation. It is a quality improvement initiative designed by Emergency Medicine and Intensive Care physicians and approved for implementation by Executive members of both departments. ELVIS will be introduced as a quality improvement initiative to senior medical staff (specialist Emergency Physicians and senior registrars), Clinical Nurse Educators and resus- trained nurses via formal in-services. Implementation will take place once 75% of these staff have been educated and signed off for use. Following the implementation of ELVIS, all patients aged greater than or equal to 16 years, who are mechanically ventilated in emergency department (with the exception of those excluded by clinician discretion, eg. life-threatening asthma) will have their ventilation strategy optimised by the ELVIS guideline. Prospective data will be collected on all mechanically ventilated patients for one year following implementation to ensure quality improvement outcomes are being reached.
Sponsors
Liverpool Hospital
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Mechanically ventilated patients (including those intubated prehospital). Age greater than or equal to 16 years.
Exclusion criteria
1. Age less than 16 years 2. Underlying clinical condition or lung pathology not conducive to lung-protective ventilation (at discretion of treating physician).
Outcome results
None listed