Thais Dias MidegaFernando A. BozzaFlávia Ribeiro MachadoHelio Penna GuimarãesJorge I. SalluhAntonio Paulo NassarKarina Normílio-SilvaMarcus J. SchultzAlexandre Biasi CavalcantiAry Serpa NetoPedro Aniceto Nunes NetoCarlos Alberto FernandesCristiano Ávila LuchesiNatalia Rodrigues de SaRoberta Antunes Faria RodriguesLarissa Stefany RadespielVinicius Leonardo dos Santos IorioDanielle BheringViviane Ribeiro LinharesGlauco Adrieno WestphalGeonice SperottoSoraya Byana Rezende da Silva RossiThaismari Escarmanhani FerreiraEdgar de Brito SobrinhoHelder Jose Lima ReisMauricio Soares CarneiroAdriana de Oliveira Lameira VeríssimoJuliana Fernandez FernandesRodrigo Lopes FerreiraSylvania Campos PinhoLeonardo DultraLise Oliveira HizumiNeiva Fernandes de LimaAlexsandra Raimunda da SilvaLiliane dos SantosSidiner Mesquita VazJosé Marcio OliveiraMiria Bonjour LaviolaWania Vasconcelos de FreitasLeonardo PassosLigia Sarmet Cunha Farah RabelloCarollina Resende de SiqueiraLuiz Carlos de Oliveira SilvaFrancisco Felix Barreto JuniorEduarda Maria Alves CruzLuiz Marcelo Sa MalbouissonFabiola Prior CaltabelotiEstevão BassiPatrícia Regiane da SilvaFilipe CadamuroRenata Graciliano dos Santos CagnonYeh Li HoLucas Chaves NetoBruno Azevedo RandiMichele Maria Goncalves de GodoyPollyanna Dutra SobralEvônio de Barros Campelo JúniorLaercio Martins de StefanoAna Lucia GutGreicy Mara Mengue Feniman de StefanoDenise Milioli FerreiraFernanda Alves Ferreira GonçalvesFernanda Rubia Negrao AlvesWilson Nogueira FilhoRenata Ortiz MarchettiSheila SaNadia Tomiko AnabukiSilvia Regina Rios VieiraEdino ParoloKaren PradoNatalia Gomes LisboaSimone Castelo Branco FortalezaMaria Liduina Nantua Beserra PorfirioMarcela Maria Sousa ColaresRosicley Souza da SilvaMarcia VasconcelosFabio de SouzaLanese Medeiros de FigueiredoNiedila Pinheiro Bastos SeabraPaula Celia Pires de OliveiraMarcio Andrade MartinsRicardo Beduschi MullerManoela Cristina RecalcattiRiani Helenditi Fernandes Camurça MartinsLeatrice Emilia Ferreira de FrançaFrederico Bruzzi de CarvalhoGustavo Cesar Augusto MoreiraEvelin Drociunas Pacheco CechinattiAline Cristina PassosMariana da Costa FerreiraAntonio Carlos Babo RodriguesVladimir dos Santos BegniAlfredo Maximo Grilo JardimAmanda Carvalho MacielMarlus Muri ThompsonErica Palacio Berçacola PinheiroClaudio Henrique Pinto GonçalvesRicardo Schilling RosenfeldValéria Abrahao RosenfeldLeticia JapiassúFundacao Oswaldo CruzA.C.Camargo Cancer CenterHospital Israelita Albert EinsteinUniversidade Federal de Sao PauloMahidol UniversityAmsterdam UMC - University of AmsterdamUniversidade Federal do Rio de JaneiroHospital do Coração (HCor)Instituto D’Or de Pesquisa e Ensino (IDOR)2020-08-252020-08-252020-12-01Annals of Intensive Care. Vol.10, No.1 (2020)211058202-s2.0-85085976135https://repository.li.mahidol.ac.th/handle/123456789/58002© 2020, The Author(s). Background: Survival benefit from low tidal volume (VT) ventilation (LTVV) has been demonstrated for patients with acute respiratory distress syndrome (ARDS), and patients not having ARDS could also benefit from this strategy. Organizational factors may play a role on adherence to LTVV. The present study aimed to identify organizational factors with an independent association with adherence to LTVV. Methods: Secondary analysis of the database of a multicenter two-phase study (prospective cohort followed by a cluster-randomized trial) performed in 118 Brazilian intensive care units. Patients under mechanical ventilation at day 2 were included. LTVV was defined as a VT ≤ 8 ml/kg PBW on the second day of ventilation. Data on the type and number of beds of the hospital, teaching status, nursing, respiratory therapists and physician staffing, use of structured checklist, and presence of protocols were tested. A multivariable mixed-effect model was used to assess the association between organizational factors and adherence to LTVV. Results: The study included 5719 patients; 3340 (58%) patients received LTVV. A greater number of hospital beds (absolute difference 7.43% [95% confidence interval 0.61–14.24%]; p = 0.038), use of structured checklist during multidisciplinary rounds (5.10% [0.55–9.81%]; p = 0.030), and presence of at least one nurse per 10 patients during all shifts (17.24% [0.85–33.60%]; p = 0.045) were the only three factors that had an independent association with adherence to LTVV. Conclusions: Number of hospital beds, use of a structured checklist during multidisciplinary rounds, and nurse staffing are organizational factors associated with adherence to LTVV. These findings shed light on organizational factors that may improve ventilation in critically ill patients.Mahidol UniversityMedicineArticleSCOPUS10.1186/s13613-020-00687-3