The Role of a Virtual Respiratory Therapist (VRT) for Mechanical Ventilation Protocol Tidal Volume Compliance

Background: Intensive care unit patients that require mechanical ventilator support can develop pulmonary complications which substantially alter their outcome. The benefits of mechanical ventilation are well documented however, there is evidence from randomized clinical trials that establishes risk factors of mechanical ventilation. These risk factors have the potential to injure the lung. Risk factors include managing oxygen, pressure and volume delivery to avoid injurious conditions that have been linked to acute lung injury and acute respiratory distress syndrome. The application of a virtual respiratory therapist (VRT) assists in the monitoring and maintenance of safe mechanical ventilation. Methods: IRB approval was received from Atrium Health. Our facility implemented a program in which a VRT assesses all newly mechanically ventilated patients for delivered volume compliance of 6-8 mL/kg of ideal body weight (IBW) for the systems mechanical ventilation protocol. Data was collected by the VRT team for 6831 ventilator patient assessments and interventions from January 2018 through December 2019. VRTs also modify all protocol initiated mechanical ventilation physician orders with the patientIs IBW and tidal volume range per the systemIs mechanical ventilation protocol to continue to improve compliance. Results: Patients without VRT intervention were found to be out of protocol compliance in 2018 and 2019 of 14.92% and 13.98%, but after VRT intervention, out of protocol compliance improved to 8.46% in 2018 and 8.48% in 2019. Therefore, 377 more patients were then within tidal volume protocol compliance. After the VRT interventions, the total compliance for 2018 and 2019 increased to 91.5% each year. Conclusions: VRT intervention on mechanical ventilation tidal volume protocol compliance reveals a positive impact to improve patient care through evidence-based practice.