Practice Variability in Management of Acute Respiratory Distress Syndrome: Bringing Evidence and Clinician Education to the Bedside Using a Web-Based Teaching Tool

The full text article is temporarily unavailable.

We apologise for the inconvenience. Please try again later.

Abstract:

BACKGROUND: Clinical practice often lags behind publication of evidence-based research and national consensus guidelines. OBJECTIVE: To assess practice variability in the clinical management of acute respiratory distress syndrome (ARDS) and test an evidence-based, online clinician-education tool designed to improve intensive-care clinicians' understanding of current evidence about ARDS management. METHODS: We surveyed 117 intensive care clinicians (16 critical care physician specialists, 28 resident physicians, 50 critical care nurses, and 23 respiratory therapists) with an online questionnaire in our tertiary academic institution. Fifty of the original respondents (12 residents, 26 critical care nurses, and 12 respiratory therapists) also responded to a repeat survey that included context-sensitive hypertext links to a summary of critically appraised primary articles regarding ARDS management, to determine if the responses changed after the clinicians had read the evidence-based summary information. RESULTS: Critical care physician specialists were most likely to choose the low-tidal-volume (low-VT) ventilation strategy and protocol-based ventilator weaning and were least likely to choose neuromuscular blockade or parenteral nutrition (p < 0.05). In a paired comparison, individual respondents were more likely to choose treatment options that are based on stronger evidence (low-VT, daily interruption in sedation, and protocol weaning [p < 0.01]). We also reviewed the medical records of 100 patients who were mechanically ventilated for > 48 h, during the 6 months before and after the survey, from which we identified 45 ARDS patients. Following the clinician-education intervention, ARDS patients were less likely to receive potentially injurious high-VT ventilation (mean day-3 VT 10.3 ± 2.3 mL/kg before vs 8.9 ± 1.7 mL/kg after, p = 0.02). CONCLUSION: Web-based teaching tools are useful to educate intensive-care practitioners and to promote evidence-based practice.

Keywords: ACUTE RESPIRATORY DISTRESS SYNDROME; ARDS; COMPUTER-ASSISTED; DECISION MAKING; EDUCATION-CONTINUING; EVIDENCE-BASED MEDICINE; ONLINE SYSTEMS

Document Type: Research Article

Affiliations: 1: Department of Anesthesiology, Mayo Clinic, Rochester Minnesota 2: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester Minnesota 3: Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida

Publication date: September 1, 2004

Related content

Share Content

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
ingentaconnect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more