Salon a 13 kasim 15.45 17.00 emel eryüksel-ing

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

2. Intrathoracic Pressures and Breathing

4. Ventilation Strategies
• Improved safety
• Improved patient comfort
• Rapid response to change in patient condition

5. Ventilation Strategies
• Improved safety
• Improved patient comfort
• Rapid response to change in patient condition

6. Lung Injury Caused by Forces
at Low and High Lung Volumes
n engl j med 369;22

10. adherence to lung protective
ventilation?

11. • -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.-

12. WHY?
What causes physicians to change
the way they practice?

13. Changes in practice are
sometimes rapid and dramatic.
laparoscopic cholecystectomy …..

14. education
• Why are most physicians not influenced by
practice guidelines?

16. scientific knowledge to specific patients

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

18. • 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….

19. IDENTIFY LOCAL BARRIERS TO PRACTICE COMPLIANCE

20. diagnostic uncertainty

22. Severity

24. Patient’s Weight..
• 50+ 0.91(centimeters of height-152.4) male
• 45.5+0.91(centimeters of height-152.4)
female

26. ICU TEAM

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

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

29. • 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.

30. MEASURE PERFORMANCE

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

32. ENSURE THAT ALL PATIENTS RECEIVE THE THERAPY

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

36. Executing