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An audit on ventilator management in critical care units in National Hospital Sri Lanka

Author:

BK Udya Nirmalle Rodrigo

Registrar in Anaesthesiology, National Hospital of Sri Lanka, LK
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Abstract

Mechanical ventilation is a common life saving intervention in Intensive Care Units (ICU). Traditional approaches to mechanical ventilation use large tidal volumes which may cause volutrauma. Lung protective ventilator strategies are used to prevent this. Concept of a ventilator care bundle was introduced to improve the quality of care in ventilated patients.

The main objectives of this audit were to find out the common modes and ventilator parameters used in our ICUs and whether ventilator care bundle are used. The audit was conducted in Feb 2011. Data was collected from intubated and mechanically ventilated patients in 5 critical care units at National Hospital of Sri Lanka (NHSL). Total number of patients analyzed was 100. Ethical clearance was obtained from the NHSL ethics committee.

Of the 100 patients 65 were males and 35 were females. Highest number of patients belonged to age group of 51-60yrs, and the majority were from Neuro-Trauma ICUs (NT-ICU). Commonest mode of ventilation was SIMV/PC (45%) and CMV/VC(37%). Frequently used tidal volume/kg was 7.1-10ml/kg (63%) and the lung protective tidal volume/kg range of 4.1-7ml/kg was used only in 31%. Commonest reasons for ventilation were central nervous system (CNS) (32%) and respiratory causes (16%). Muscle relaxants were used in 54% of patients, mainly in NT-ICUs and AS-ICU. Reasons for muscle relaxation were CNS stabilization following head injury/ neurosurgical intervention (28%), and to control intra-cranial pressure (11%). 91% of patients were given sedation and sedation free window was practiced in 70% of patients. Head-up tilt was maintained in 89% of patients and the reasons for not maintaining that position was severe hypotension and cervical spine injury. Mouth care (100%) and antacid prophylaxis (99%) were practiced in almost all the patients. Regular ETT cuff pressure checking is not a common practice in our ICUs.

This audit highlight that less than 1/3 of ICU personnel practice  lung protective ventilation strategies. To improve the quality of care of ventilated patients, we recommend to conduct awareness programmes to educate the ICU staff  on the importance of practicing lung protective ventilator strategies and to introduce a system for monitoring compliance to the care bundle.

DOI: http://dx.doi.org/10.4038/slja.v20i2.4153

Sri Lankan Journal of Anaesthesiology.2012:20(2):78-83

How to Cite: Rodrigo, B.U.N., (2012). An audit on ventilator management in critical care units in National Hospital Sri Lanka. Sri Lankan Journal of Anaesthesiology. 20(2), pp.78–83. DOI: http://doi.org/10.4038/slja.v20i2.4153
Published on 09 Jul 2012.
Peer Reviewed

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