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EP.296
An educational intervention targeting ICU nurses to improve adherence to lung protective ventilation in patients after heart surgery.

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An educational intervention targeting ICU nurses to improve adherence to lung protective ventilation in patients after heart surgery

Background:

Respiratory complications develop in 25% of the patients undergoing Heart Surgery (HS), including Acute Respiratory Distress Syndrome (ARDS). Several factors contribute to ARDS after HS: 

-Cardiopulmonary Bypass (CPB)
-Lung deflation during surgery increasing atelectasis
-High volume ventilation
-Transfusion Related Lung Injury (TRALI) 
-Reperfusion injury to both heart and lung

Mechanical Ventilation (MV) playsa significant role inARDS. Ventilator Induced Lung Injury (VILI) may be mitigated by the use of lower tidal volumes (Vt): 6-8ml/kg ideal body weight (IBW) is recommended. However, adherence to low Vt MV is lacking.

Hypothesis:

An educational programme targeting ICU nurses will increase  adherence to Lung Protective Ventilation (LPV) in patients after HS.

Methodology

-A core group ofnurses were trained in ARDS prevention. Then this group disseminatedthe training to the whole ICU nursing team.
-Audits of MV parameters before and after the training were performed for 7 consecutive days for all patients after HS.
-Questionnaires assessed Nursing knowledge and confidence before and after the intervention.
-The standardised teaching intervention was independently assessed.

Fisher’s exact test was used for categorical variables. Data sets were subjected to the D'Agostino & Pearson normality test (alpha = 0.05). A Mann-Whitney U test was used when comparing populations that were not normally distributed; a significance level of p < 0.05 was set.

Discussion

-The intervention did not decrease Vt (ml/kg of IBW) on post- operative days 0 and 1 (p=0.07 and p=0.09 in day 0 and 1 respectively). Nevertheless, our sample is small.
-However, the likelihood that patients were ventilated at <8ml/kg IBW was significantly increased (95% CI 0.11-0.85; p=0.02) after the intervention. 
-Females benefited more than males from the intervention, possibly because they have a greater difference between their actual and predicted body weight.
-Calculating P/F ratios may be beneficial for patients as it can guide when to seek medical review of the MV settings. 
-Nursing confidence in managing MV settings is strongly related to personal factors such as experience and knowledge. 
-Not only personal but organisational factors play an important role in nursing confidence when challenging medical team.

Conclusion
 

Despite gaps in nursing knowledge, fewer patients were ventilated with presumed injurious Vt (>8ml/kg IBW) after targeted training. Nurses have the potential to improve adherence to evidence based interventions. For that reason, continuous nursing education has the potential todecrease the incidence of ARDS by increasing adherence to evidence-base care in high risk patients.




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