Implementing effective ventilator practice at the bedside.

PURPOSE OF REVIEW: New data on the efficacy of low tidal volume ventilation for acute lung injury, noninvasive ventilation for chronic obstructive pulmonary disease exacerbation, weaning from mechanical ventilation, and prevention of ventilator-associated pneumonia provide, for perhaps the first time in respiratory care, compelling evidence for clinicians to change practice. However, experience from every other field in medicine suggests that there will be significant barriers to changing clinical practice at the bedside. Studies on implementation of effective practice in medicine shows that a multifaceted, team-oriented approach incorporating reminders, efficient use of non-physician personnel, protocols, and education is required to change clinical practice. Limited data on current practice of mechanical ventilation suggest that it deviates from recommended practice. Unfortunately, there are no studies exploring community-based implementation of mechanical ventilation guidelines and only a few studies to inform clinicians as to why ventilator practice may be difficult to change. As the evidence base grows for effective critical care practice, so does the responsibility to translate practices that improve outcome from research journals to patients' bedsides. Strategies for doing this are presented in the review.