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English
Gil Ben-Horin
Published: Aug 16, 2012
Mechanical ventilation is often essential for patient care in the ICU, but can be associated with serious complications. Ventilator-associated lung injury is related to increased mortality and morbidity and should be prevented by applying lower tidal volumes (VT). Academic Medical Center in the Netherlands developed and implemented an active computerised decision support system (CDSS) using MetaVision that worked in two different ways: a consulting style that always shows the preferred VT, and in a critiquing style that shows the preferred VT only if VT is above the desired threshold. The hospital performed a prospective, off-on-off-on study to measure the effect of an active CDSS for these two communication styles, consulting and critiquing, on adherence to VT recommendations. The study found that the use of a CDSS in both communication styles improved the use of lower VTs for ventilated patients. When decision support was not sustained, adherence to low VT fell back to its original value. The consulting style was found to be slightly more effective than the critiquing style, which the study authors postulate may stem from the high frequency of showing reminders in this style and the relatively simple underlying guideline whereby display of the reminder prompts the clinician to check the VT and adjust it if required.
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