|
Deep Blue at the University of Michigan >
All Collections >
Pulmonary & Critical Care Medicine, Division of >
|
Please use this persistent URL to cite or link to this item:
|
| Title: | The effect of an intensive care unit staffing model on tidal volume in patients with acute lung injury |
| Authors: | Cooke, Colin
Watkins, Timothy
Kahn, Jeremy
Treggiari, Miriam
Caldwell, Ellen
Hudson, Leonard
Rubenfeld, Gordon |
| Keywords: | Personnel Staffing and Scheduling
Tidal Volume
Intensive Care Units
Acute Lung Injury |
| Issue Date: | 3-Nov-2008 |
| Publisher: | BioMed Central Ltd |
| Citation: | Critical Care 2008, 12:R134 |
| Abstract: | Introduction
Little is known about the mechanisms through which intensivist physician staffing influences patient outcomes. We aimed to assess the effect of closed-model intensive care on evidence-based ventilatory practice in patients with acute lung injury (ALI).
Methods
We conducted a secondary analysis of a prospective population-based cohort of 759 patients with ALI who were alive and ventilated on day three of ALI, and were cared for in 23 intensive care units (ICUs) in King County, Washington.
Results
We compared day three tidal volume (VT) in open versus closed ICUs adjusting for potential patient and ICU confounders. In 13 closed model ICUs, 429 (63%) patients were cared for. Adjusted mean VT (mL/Kg predicted body weight (PBW) or measured body weight if height not recorded) for patients in closed ICUs was 1.40 mL/Kg PBW (95% confidence interval (CI) = 0.57 to 2.24 mL/Kg PBW) lower than patients in open model ICUs. Patients in closed ICUs were more likely (odds ratio (OR) = 2.23, 95% CI = 1.09 to 4.56) to receive lower VT (≤ 6.5 mL/Kg PBW) and were less likely (OR = 0.30, 95% CI = 0.17 to 0.55) to receive a potentially injurious VT (≥ 12 mL/Kg PBW) compared with patients cared for in open ICUs, independent of other covariates. The effect of closed ICUs on hospital mortality was not changed after accounting for delivered VT.
Conclusions
Patients with ALI cared for in closed model ICUs are more likely to receive lower VT and less likely to receive higher VT, but there were no other differences in measured processes of care. Moreover, the difference in delivered VT did not completely account for the improved mortality observed in closed model ICUs. |
| PMID: | 18980682 |
| Appears in Collections: | Interdisciplinary and Peer-Reviewed
Pulmonary & Critical Care Medicine, Division of
|
Files in This Item:
| File |
Description |
Size | Format | |
|---|
| Cooke - Effect of ICU model on Vt.pdf | Main article | 264Kb | Adobe PDF | View/Open |
|
Deep Blue encourages the fair use of copyrighted material, and you are free to link to content here without asking for permission. Consult the document(s) and/or contact the copyright holder for additional rights questions and requests.
|
