Implementation of Neuro Lung Protective Ventilation

Patients who experience lung injury are often placed on a ventilator to help them heal;
however, if the ventilator volume settings are too high, it can cause additional lung injury.
It is proven that using lower ventilator volume settings improves outcomes. In patients with
acute brain injury, it is proven that maintaining a normal partial pressure of carbon dioxide
in the arterial blood improves outcomes. Mechanical ventilator settings with higher volumes
and higher breathing rates are sometimes required to maintain a normal partial pressure of
carbon dioxide. These 2 goals of mechanical ventilation, using lower volumes to prevent
additional lung injury but maintaining a normal partial pressure of carbon dioxide, are both
important for patients with acute brain injury. The investigators have designed a
computerized ventilator protocol in iCentra that matches the current standard of care for
mechanical ventilation of patients with acute brain injury by targeting a normal partial
pressure of carbon dioxide with the lowest ventilator volume required.

This is a quality improvement study with the purpose of observing and measuring the effects
of implementation of a standard of care mechanical ventilation protocol for patients with
acute brain injury in the iCentra electronic medical record system at Intermountain Medical
Center. We hypothesize that implementation of a standardized neuro lung protective
ventilation protocol will be feasible, will achieve a target normal partial pressure of
carbon dioxide, will decrease tidal volumes toward the target 6 mL/kg predicted body weight,
and will improve outcomes.