Observational studyBMJ open2016
Increasing compliance with low tidal volume ventilation in the ICU with two nudge-based interventions: evaluation through intervention time-series analyses.
Observational study in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
34 citing papers in PubMed, 2 syntheses or guidelines pooled it, 69 citations in OpenAlex.
- Novel displays of patient information in critical care settings: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2019Pooled it
- Behavioral Economics Interventions in Clinical Decision Support Systems.Yearbook of medical informatics · 2018Pooled it
- Determinants of Adoption of a Mechanical Ventilation Dashboard in Intensive Care: Measurement Instrument for Determinants of Innovations-Based, Single-Center, Cross-Sectional Evaluation.JMIR human factors · 2026Article
- Article
- Review
- Using a clinical decision support system to reduce excess driving pressure: the ALARM trial.BMC medicine · 2025Article
- Quality improvement project to improve adherence to lung protective ventilation guidelines.BMJ open quality · 2024Article
- Design and Evaluation of an Intensive Care Unit Dashboard Built in Response to the COVID-19 Pandemic: Semistructured Interview Study.JMIR human factors · 2023Article
- Evaluation of an approach to clinical decision support for preventing inpatient falls: a pragmatic trial.JAMIA open · 2023Article
- Understanding clinical and biological heterogeneity to advance precision medicine in paediatric acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2023Review
- We can't mitigate what we don't monitor: using informatics to measure and improve healthcare systems' climate impact and environmental footprint.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- A nudge intervention to improve hand hygiene compliance in the hospital.Internal and emergency medicine · 2022Article
- Requirements for a Bespoke Intensive Care Unit Dashboard in Response to the COVID-19 Pandemic: Semistructured Interview Study.JMIR human factors · 2022Article
- Improving delivery of low tidal volume ventilation in 10 ICUs.BMJ open quality · 2022Article
- Use of a Portable Electronic Interface Improves Clinical Handoffs and Adherence to Lung Protective Ventilation.Medical devices (Auckland, N.Z.) · 2022Article
- Nudging healthcare professionals to improve treatment of COVID-19: a narrative review.BMJ open quality · 2021Review
- Nudging healthcare professionals in clinical settings: a scoping review of the literature.BMC health services research · 2021Article
- Implementation of lung protective ventilation order to improve adherence to low tidal volume ventilation: A RE-AIM evaluation.Journal of critical care · 2021Article
- Impact of a computerized decision support tool deployed in two intensive care units on acute kidney injury progression and guideline compliance: a prospective observational study.Critical care (London, England) · 2020Observational
- Comparing regression and neural network techniques for personalized predictive analytics to promote lung protective ventilation in Intensive Care Units.Computers in biology and medicine · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
Abstract
objectivesLow tidal volume (TVe) ventilation improves outcomes for ventilated patients, and the majority of clinicians state they implement it. Unfortunately, most patients never receive low TVes. 'Nudges' influence decision-making with subtle cognitive mechanisms and are effective in many contexts. There have been few studies examining their impact on clinical decision-making. We investigated the impact of 2 interventions designed using principles from behavioural science on the deployment of low TVe ventilation in the intensive care unit (ICU).
settingUniversity Hospitals Bristol, a tertiary, mixed medical and surgical ICU with 20 beds, admitting over 1300 patients per year.
participantsData were collected from 2144 consecutive patients receiving controlled mechanical ventilation for more than 1 hour between October 2010 and September 2014. Patients on controlled mechanical ventilation for more than 20 hours were included in the final analysis.
interventions(1) Default ventilator settings were adjusted to comply with low TVe targets from the initiation of ventilation unless actively changed by a clinician. (2) A large dashboard was deployed displaying TVes in the format mL/kg ideal body weight (IBW) with alerts when TVes were excessive. PRIMARY OUTCOME MEASURE: TVe in mL/kg IBW.
findingsTVe was significantly lower in the defaults group. In the dashboard intervention, TVe fell more quickly and by a greater amount after a TVe of 8 mL/kg IBW was breached when compared with controls. This effect improved in each subsequent year for 3 years.
conclusionsThis study has demonstrated that adjustment of default ventilator settings and a dashboard with alerts for excessive TVe can significantly influence clinical decision-making. This offers a promising strategy to improve compliance with low TVe ventilation, and suggests that using insights from behavioural science has potential to improve the translation of evidence into practice.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.