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Review
. 2021 Apr 26;3(4):e0391.
doi: 10.1097/CCE.0000000000000391. eCollection 2021 Apr.

Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

Shewit P Giovanni  1 , Ann L Jennerich  2 , Tessa L Steel  2   3   4 , Sharukh Lokhandwala  5 , Waleed Alhazzani  6   7 , Curtis H Weiss  8 , Catherine L Hough  1
Affiliations
Review

Promoting Evidence-Based Practice in Acute Respiratory Distress Syndrome: A Systematic Review

Shewit P Giovanni et al. Crit Care Explor. .

Abstract

Low tidal volume ventilation and prone positioning are recommended therapies yet underused in acute respiratory distress syndrome. We aimed to assess the role of interventions focused on implementation of low tidal volume ventilation and prone positioning in mechanically ventilated adult patients with acute respiratory distress syndrome.

Data sources: PubMed, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials.

Study selection: We searched the four databases from January 1, 2001, to January 28, 2021, for studies that met the predefined search criteria. Selected studies focused on interventions to improve implementation of low tidal volume ventilation and prone positioning in mechanically ventilated patients with acute respiratory distress syndrome.

Data extraction: Two authors independently performed study selection and data extraction using a standardized form.

Data synthesis: Due to methodological heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome.

Measurements and main results: Two authors independently performed study selection and data extraction using a standardized form. Due to methodologic heterogeneity of included studies, meta-analysis was not feasible; thus, we provided a narrative summary and assessment of the literature. Eight nonrandomized studies met our eligibility criteria. Most studies looked at interventions to improve adherence to low tidal volume ventilation. Most interventions focused on education for providers. Studies were primarily conducted in the ICU and involved trainees, intensivists, respiratory therapists, and critical care nurses. Although overall quality of the studies was very low, the primary outcomes of interest suggest that interventions could improve adherence to or implementation of low tidal volume ventilation and prone positioning in acute respiratory distress syndrome.

Conclusions: There is a dearth of literature addressing interventions to improve implementation of evidence-based practices in acute respiratory distress syndrome. Existing interventions to improve clinician knowledge and facilitate application of low tidal volume ventilation and prone positioning may be effective, but supporting studies have significant limitations.

Keywords: acute respiratory distress syndrome; adherence; implementation; prone position; systematic review; tidal volume.

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Conflict of interest statement

Dr. Giovanni received support from the National Institutes of Health (NIH) grant T32 HL 007287. Dr. Weiss received support from the National Heart lung and Blood Institute. Dr. Hough received support from NIH grant 5K24 HL 141526. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses inclusion diagram.
See this image and copyright information in PMC

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