ARDS Net clinical trials suggest that maintaining inspiratory plateau pressures < 30 cm H2O (when accompanied by a low-tidal volume ventilation strategy of 6 ml/kg) reduces mortality in patients with lung injury. Many mechanically ventilated patients with severe sepsis and/or septic shock will meet criteria for lung injury or acute respiratory distress syndrome and could benefit from inspiratory plateau pressures < 30 cm H2O.

Compliance with this bundle element is defined as the percent of patients requiring mechanical ventilation who have a median IPP < 30 cm H2O over the first 24 hours following presentation with severe sepsis and/or septic shock.

Numerator: Number of mechanically ventilated patients with severe sepsis and/or septic shock who had a median IPP < 30 cm H2O over the first 24 hours following presentation with severe sepsis and/or septic shock

Denominator: Number of mechanically ventilated patients presenting with severe sepsis and/or septic shock

Exclusion: Patients not mechanically ventilated

Increase the number of cases of mechanically ventilated patients with severe sepsis and/or septic shock who maintain inspiratory plateau pressures < 30 cm H2O to 100 percent.

Data may be collected concurrently — that is, once a patient is placed on the hospital’s severe sepsis protocol, data can be abstracted from the patient chart in real time — or retrospectively using a chart review, a method generally recommended for more experienced improvement teams.