• Briana Short, Alexis Serra, Abdul Tariq, Vivek Moitra, Daniel Brodie, Sapana Patel, Matthew R Baldwin, and Natalie H Yip.
• Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America. Electronic address: bs2886@cumc.columbia.edu.
• J Crit Care. 2021 Jun 1; 63: 167-174.

PurposeLung protective ventilation (LPV), defined as a tidal volume (Vt) ≤8 cc/kg of predicted body weight, reduces ventilator-induced lung injury but is applied inconsistently.Materials And MethodsWe conducted a prospective, quasi-experimental, cohort study of adults mechanically ventilated admitted to intensive care units (ICU) in the year before, year after, and second year after implementation of an electronic medical record based LPV order, and a cross-sectional qualitative study of ICU providers regarding their perceptions of the order. We applied the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework to evaluate the implementation.ResultsThere were 1405, 1424, and 1342 in the control, adoption, and maintenance cohorts, representing 95% of mechanically ventilated adult ICU patients. The overall prevalence of LPV increased from 65% to 73% (p < 0.001, adjusted-OR for LPV adherence: 1.9, 95% CI 1.5-2.3), but LPV adherence in women was approximately 30% worse than in men (women: 44% to 56% [p < 0.001],men: 79% to 86% [p < 0.001]). ICU providers noted difficulty obtaining an accurate height measurement and mistrust of the Vt calculation as barriers to implementation. LPV adherence increased further in the second year post implementation.ConclusionWe designed and implemented an LPV order that sustainably improved LPV adherence across diverse ICUs.Copyright © 2020 Elsevier Inc. All rights reserved.

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