A multicenter population-based effectiveness study of teleintensive care unit-directed ventilator rounds demonstrating improved adherence to a protective lung strategy, decreased ventilator duration, and decreased intensive care unit mortality

Purpose of the study: The purpose of the study is to determine if teleintensive care unit (ICU)-directed daily ventilator rounds improved adherence to lung protective ventilation (LPV), reduced ventilator duration ratio (VDR), and ICU mortality ratios.

Method used: A retrospective observational longitudinal quarterly analysis of adherence to low tidal volume LPV (<7.5 mL/kg predicted body weight; Pao2/fraction of inspired oxygen<300), ventilator duration, and ICU mortality ratios (Acute Physiology and Chronic Health Evaluation IV-adjusted). The teleICU practice used Philips (Andover, MA) VISICU eCareManagerTM (Andover, MA) platform, providing ICU care and process improvement.

Results: Before ventilator rounds implementation, there was wide variation in hospital adherence to low tidal volume (29.5±18.2; range 10%-69%). Longitudinal improvement was seen across hospitals in the 3 Qs after implementation, reaching statistical significance by Q3 postimplementation (44.9±15.7; P<.002 by 2-tailed Fisher exact test), maintained at 2 subsequent Qs (48% and 52%; P<.001). Ventilator duration ratio also showed preimplementation variability (1.08±.34; range 0.71-1.90). After implementation, absolute and significant mean VDR reduction was observed (0.92±.28; -15.8%, P<.05). Intensive care unit mortality ratio demonstrated longitudinal improvement, reaching significance after the Q3 postimplementation (0.94 vs 0.67; P<.04), and this was sustained in the most recent Q analyzed (0.65; P<.03).

Conclusions: Implementation of teleICU-directed ventilator rounds was associated with improved and durable adherence to LPV and significant reductions in both VDR and ICU mortality.