Impact of a clinical audit on the improvement of mechanical ventilation for patients admitted to a postoperative care unit

Abstract

Objective: describe the adherence to lung protective mechanical ventilation recommendations, before and after implementing educational interventions in our postoperative intensive care unit, by conducting three cycles of clinical audit.

Material and methods: longitudinal and descriptive study carried out in a single centre.  Data collection took place in three different periods, the first audit was carried out in 2017 and results were obtained from arterial blood samples and mechanical ventilation registry. Ventilation was classified into three categories: unnecessary hyperventilation, acceptable ventilation and optimal ventilation. After the first cycle, several educational interventions were implemented and a lung protective ventilation protocol was created.  After the application of these measures, a second audit was carried out in 2018 and another in 2019.

Results: following the implementation of the previous measures, the rate of unnecessary hyperventilation decreased from 15% to 1,9% and the rate of optimal ventilation increased from 2% to 22.9%. There was a significant shift from the initial broad use of pressure-controlled ventilation (66% of registrations in 2017) to a later predominant use of volume-controlled ventilation (89% in 2019).

Conclusions: clinical audit is a useful tool to improve our clinical practice. We have demonstrated an improvement in mechanical ventilation parameters in patients admitted to our postoperative care unit, after implementing some educational and feedback measures.