Reducing Friction in Low Tidal Volume Ventilation
For mechanically intubated patients in the emergency department, we aim for a tidal volume of 6-8cc/kg of ideal body weight. But calculating the ideal body weight depends on knowing the patient’s height. Bedside clinicians have various methods for figuring this out - asking the patient (difficult if they were emergently intubated or altered), guessing (which is prone to a lot of error), or that trick where people stand on one leg, lean back, and compare their height against the patient. But the accuracy of these pales in comparison to just measuring the patient with a tape measure. How much of a difference does this make? A group from the University of Michigan’s Emergency Critical Care Center (EC3) found by giving their respiratory therapists tape measures and including a best practice advisory in the electronic medical record, they significantly improved the frequency of measuring patients and an improvement in using tidal volumes less than 8cc/kg IBW. One way to help “nudge” clinicians to use best evidence practices is to reduce the friction they encounter between wanting to do the right thing and doing it. Ensuring everyone has the supplies they need and a reminder to do the right thing can make a difference.
Reference: Tallman CMI, Harvey CE, Laurinec SL, et al. Impact of Providing a Tape Measure on the Provision of Lung-protective Ventilation. West J Emerg Medicine Integrating Emerg Care Popul Heal. 2021;22(2):389-393. doi:10.5811/westjem.2020.10.49104