Salon a 13 kasim 15.45 17.00 emel eryüksel-ing

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What Differs from Theory to Practice? Emel Eryüksel Marmara University, Pulmonary and Critical Care

Transcript of Salon a 13 kasim 15.45 17.00 emel eryüksel-ing

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What Differs from Theory to Practice?

Emel EryükselMarmara University, Pulmonary and

Critical Care

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Intrathoracic Pressures and Breathing

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Ventilation Strategies

• Improved safety

• Improved patient comfort

• Rapid response to change in patient condition

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Ventilation Strategies

• Improved safety

• Improved patient comfort

• Rapid response to change in patient condition

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Lung Injury Caused by Forcesat Low and High Lung Volumes

n engl j med 369;22

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adherence to lung protective ventilation?

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• -Of the 485 patients, 417 (86%) received 50% or less and 68 (14%)

received more than 50% of their twice daily ventilator settings adherent to

lung protective ventilation. A total of 180 (37%) patients never received

lung protective ventilation during any of their twice daily ventilator

settings.-

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WHY?

What causes physicians to change the way they practice?

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Changes in practice are sometimes rapid and dramatic.

laparoscopic cholecystectomy …..

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education

• Why are most physicians not influenced by practice guidelines?

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scientific knowledge to specific patients

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SUMMARIZE THE EVIDENCE

• To change practice, the evidence must be summarized concisely into several key interventions….

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• For ALI, the evidence supports LPV, which can be defined as providing a tidal volume less than or equal to 6 ml/kg of predicted body weight and a plateau pressure of less than or equal to 30 cm H2O….

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IDENTIFY LOCAL BARRIERS TO PRACTICE COMPLIANCE

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diagnostic uncertainty

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Severity

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Patient’s Weight..

• 50+ 0.91(centimeters of height-152.4) male

• 45.5+0.91(centimeters of height-152.4) female

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ICU TEAM

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• Overall, organizational barriers and perceived barriers related to clinician attitudes and behaviors were lower among physicians compared with nurses and respiratory therapists.

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• Physicians specializing in internal medicine (including pulmonary/critical care) perceived lower barriers and scored higher on the Knowledge Test compared with surgery

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• Barriers were lower and Knowledge Test scores higher among fellows and attending physicians vs. interns and residents, who have much less experience working in the ICU.

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MEASURE PERFORMANCE

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• Clinicians can measure performance using processes of care (e.g., LPV use), outcomes of care (in-hospital mortality)or both.

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ENSURE THAT ALL PATIENTS RECEIVE THE THERAPY

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Educating clinicians

• that they are aware of the evidence, agree with it, and understand the actions needed to comply with the evidence.

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Executing

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