The effect of an intensive care unit staffing model on tidal volume in patients with acute lung injury
dc.contributor.author | Cooke, Colin | |
dc.contributor.author | Watkins, Timothy | |
dc.contributor.author | Kahn, Jeremy M. | |
dc.contributor.author | Treggiari, Miriam | |
dc.contributor.author | Caldwell, Ellen | |
dc.contributor.author | Hudson, Leonard | |
dc.contributor.author | Rubenfeld, Gordon | |
dc.date.accessioned | 2009-10-08T20:00:41Z | |
dc.date.available | 2009-10-08T20:00:41Z | |
dc.date.issued | 2008-11-03 | |
dc.identifier.citation | Critical Care 2008, 12:R134 <http://hdl.handle.net/2027.42/64239> | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/64239 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=18980682&dopt=citation | en_US |
dc.description.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. | en_US |
dc.description.sponsorship | NIH SCOR HL30542, R01HL67939, F32HL090220 | en_US |
dc.format.extent | 271156 bytes | |
dc.format.mimetype | application/pdf | |
dc.language.iso | en_US | en_US |
dc.publisher | BioMed Central Ltd | en_US |
dc.subject | Personnel Staffing and Scheduling | en_US |
dc.subject | Tidal Volume | en_US |
dc.subject | Intensive Care Units | en_US |
dc.subject | Acute Lung Injury | en_US |
dc.title | The effect of an intensive care unit staffing model on tidal volume in patients with acute lung injury | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Internal Medicine and Specialities | |
dc.subject.hlbtoplevel | Health Sciences | |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Pulmonary and Critical Care Medicine, Division of | en_US |
dc.contributor.affiliationum | Robert Wood Johnson Clinical Scholars Program | en_US |
dc.contributor.affiliationum | Internal Medicine, Department of | en_US |
dc.contributor.affiliationumcampus | Ann Arbor | en_US |
dc.identifier.pmid | 18980682 | |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/64239/1/Cooke - Effect of ICU model on Vt.pdf | |
dc.identifier.source | Critical Care | en_US |
dc.owningcollname | Pulmonary & Critical Care Medicine, Division of |
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