TY - JOUR
T1 - Barriers to low tidal volume ventilation in acute respiratory distress syndrome
T2 - Survey development, validation, and results
AU - Dennison, Cheryl R.
AU - Mendez-Tellez, Pedro A.
AU - Wang, Weiwei
AU - Pronovost, Peter J.
AU - Needham, Dale M.
N1 - Funding Information:
Supported, in part, by National Institutes of Health (Acute Lung Injury SCCOR Grant P050 HL 73994). Dr. Dennison is supported by a Mentored Patient-Oriented Research Career Development Award from the National Institutes of Health (K23 NR009193); Dr. Needham is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research. The funding bodies had no role in the study design, manuscript writing, or decision to submit the manuscript for publication.
PY - 2007/12
Y1 - 2007/12
N2 - OBJECTIVE: To evaluate perceived attitudes, knowledge, and behaviors regarding the use of low tidal volume ventilation in acute respiratory distress syndrome among physicians, nurses, and respiratory therapists in intensive care units. DESIGN: Cross-sectional, self-administered survey. SETTING: Large Acute Respiratory Distress Syndrome Network teaching hospital in Baltimore, MD. PARTICIPANTS: Attending, fellow, and resident physicians; staff nurses; and respiratory therapists in three intensive care units. INTERVENTIONS: A survey was designed to assess barriers related to clinicians' perceived attitudes, knowledge, and behaviors related to low tidal volume ventilation in acute respiratory distress syndrome and intensive care unit organization-related barriers. Survey development was guided by a published framework of barriers to clinician adherence to practice guidelines; individual items were derived through literature review and refined through pilot testing. Content validity, face validity, and ease of use were verified by local clinicians. Psychometric properties were assessed and regression analyses were conducted to examine differences in perceptions and knowledge level by provider discipline and training level. MEASUREMENTS AND MAIN RESULTS: There were 291 completed surveys with a response rate of 84%. Validity and acceptable psychometric properties were demonstrated. Barriers related to clinician attitudes, behaviors, and intensive care unit organization were significantly higher among nurses and respiratory therapists vs. physicians. Knowledge-related barriers also were significantly higher among nurses vs. physicians and respiratory therapists. Barriers were lower and knowledge test scores higher among fellows and attending physicians vs. residents. Similarly, barriers were lower and knowledge test scores higher among nurses with >10 yrs of experience vs. <10 yrs of experience. CONCLUSIONS: Important organizational and clinician barriers, including knowledge deficits, regarding low tidal volume ventilation were reported, particularly among nurses and resident physicians. Addressing these barriers may be important for increasing implementation of low tidal volume ventilation.
AB - OBJECTIVE: To evaluate perceived attitudes, knowledge, and behaviors regarding the use of low tidal volume ventilation in acute respiratory distress syndrome among physicians, nurses, and respiratory therapists in intensive care units. DESIGN: Cross-sectional, self-administered survey. SETTING: Large Acute Respiratory Distress Syndrome Network teaching hospital in Baltimore, MD. PARTICIPANTS: Attending, fellow, and resident physicians; staff nurses; and respiratory therapists in three intensive care units. INTERVENTIONS: A survey was designed to assess barriers related to clinicians' perceived attitudes, knowledge, and behaviors related to low tidal volume ventilation in acute respiratory distress syndrome and intensive care unit organization-related barriers. Survey development was guided by a published framework of barriers to clinician adherence to practice guidelines; individual items were derived through literature review and refined through pilot testing. Content validity, face validity, and ease of use were verified by local clinicians. Psychometric properties were assessed and regression analyses were conducted to examine differences in perceptions and knowledge level by provider discipline and training level. MEASUREMENTS AND MAIN RESULTS: There were 291 completed surveys with a response rate of 84%. Validity and acceptable psychometric properties were demonstrated. Barriers related to clinician attitudes, behaviors, and intensive care unit organization were significantly higher among nurses and respiratory therapists vs. physicians. Knowledge-related barriers also were significantly higher among nurses vs. physicians and respiratory therapists. Barriers were lower and knowledge test scores higher among fellows and attending physicians vs. residents. Similarly, barriers were lower and knowledge test scores higher among nurses with >10 yrs of experience vs. <10 yrs of experience. CONCLUSIONS: Important organizational and clinician barriers, including knowledge deficits, regarding low tidal volume ventilation were reported, particularly among nurses and resident physicians. Addressing these barriers may be important for increasing implementation of low tidal volume ventilation.
KW - Acute respiratory distress syndrome
KW - Critical care
KW - Evidence-based care
KW - Mechanical ventilation
KW - Multidisciplinary
KW - Provider practice
KW - Survey
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U2 - 10.1097/01.CCM.0000287591.09487.70
DO - 10.1097/01.CCM.0000287591.09487.70
M3 - Article
C2 - 17901838
AN - SCOPUS:36448995837
SN - 0090-3493
VL - 35
SP - 2747
EP - 2754
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -