The role of computer-based clinical decision support systems to deliver protective mechanical ventilation.
The role of computer-based clinical decision support systems to deliver protective mechanical ventilation.
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DOI：
10.1097/mcc.0000000000000688
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发表时间：
2020-02
影响因子：
3.3
通讯作者：
Newth CJL
中科院分区：
文献类型：
--
作者：
Khemani RG;Hotz JC;Sward KA;Newth CJL
成人和儿童急性呼吸衰竭的机械通气需要平衡肺和膈肌保护性通气。计算机化决策支持（CDS）在需要根据患者的生理状态做出复杂决策以权衡潜在竞争风险的情况下具有优势。在如何应用呼吸机协议方面仍然存在显著的差异，临床数据表明，呼吸机管理仍然存在广泛的差异。我们已经开发了CDS，目前正在进行II期随机对照试验。CDS被称为实时努力驱动呼吸机管理（REDvent）。我们将以REDvent CDS为例，描述用于肺和膈肌保护性通气的CDS的开发原理和方法。当CDS指令简单明确、为临床医生提供基本规则集、允许可接受的拒绝理由并允许迭代调整时，可以满足实现顺应性和生理目标的目标。
Mechanical ventilation of adults and children with acute respiratory failure necessitates balancing lung and diaphragm protective ventilation. Computerized decision support (CDS) offers advantages in circumstances where complex decisions need to be made to weigh potentially competing risks, depending on the physiologic state of the patient. Significant variability in how ventilator protocols are applied still exists and clinical data show that there continues to be wide variability in ventilator management. We have developed a CDS, which we are currently testing in a Phase II randomized controlled trial. The CDS is called Real-time Effort Driven ventilator management (REDvent). We will describe the rationale and methods for development of CDS for lung and diaphragm protective ventilation, using the REDvent CDS as an exemplar. Goals for achieving compliance and physiologic objectives can be met when CDS instructions are simple and explicit, provide the clinician with the underlying rule set, permit acceptable reasons for declining and allow for iterative adjustments.