6373 Audit on adherence to protective lung ventilation strategy in paediatric ICU

Objectives Mechanical ventilation is utilized in the PICU for various conditions. A lung-protective strategy is crucial to prevent ventilation-induced lung injury.¹ This audit assesses adherence to.² Methods A pilot observational audit to evaluate adherence to lung-protective Vt delivery according to PALICC guidelines. Review of ventilator settings, diagnoses, and oxygenation indices for patients in invasive mode on Servo I/U ventilators, excluding other modes (HFOV, LTV, NIV, and HFNC). We assessed adherence to the recommended low Vt strategy (6–8 ml/kg), with adjustments to 4–6 ml/kg for patients with poor respiratory compliance and elevated p-plat/DP. Emphasis was placed on prescribing Vt using the lower of actual body weight or ideal body weight (IBW). We conducted an evaluation of a subset of patients who met the p-ARDS criteria as defined by the PALICC guidelines, employing the Oxygenation Index (OI) (2). Results 30 ventilated patients met the inclusion criteria, with 10 meeting the criteria. Of these, 29 were on SIMV/PRVC mode and 1 on PRVC mode on servo ventilators. Notably, 25 of the 30 patients had Vt prescribed using their current weight alone, neglecting IBW. Retrospectively, 19 of these patients had a lower IBW, which should have been used to set Vt. The average weight difference between patients' weight and IBW was 10.9% (ranging from 3.3% to 31.67%). Consequently, 2 out of 25 patients (8%) who used their current body weight exceeded the recommended Vt (>8 ml/kg). In contrast, 1 out of 5 patients who were ventilated after comparing both weights, upper limit of lung protective ventilation, i.e. Vt >8ml/kg. Conclusion This pilot audit highlights baseline low compliance with PALICC lung-protective ventilation guidelines. The Vt was not routinely based on the lower of actual body weight and ideal body weight. To improve adherence, the authors propose additional education for clinical staff, emphasizing the importance of regularly calculating IBW, routines to ensure patient anthropometric measurements and comparison of IBW to current weight for tidal volume prescription. A repeat of the audit is planned following educational intervention. References Brower RG, Matthay MA, et al. Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301–1308. Emeriaud G, López-Fernández YM, Iyer NP, et al. Pediatr Crit Med.2023;24(2):143–168.