Clinical Impact of an Electronic Dashboard and Alert System for Sedation Minimization and Ventilator Liberation: A Before-After Study.
Clinical Impact of an Electronic Dashboard and Alert System for Sedation Minimization and Ventilator Liberation: A Before-After Study.
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DOI：
10.1097/cce.0000000000000057
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发表时间：
2019-10-01
影响因子：
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通讯作者：
Fuchs, Barry D
中科院分区：
文献类型：
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作者：
Anderson, Brian J;Do, David;Fuchs, Barry D
镇静最小化和呼吸机释放协议改善结果，但实施具有挑战性。设计：多ICU概念验证研究和单一ICU前后研究。设置：大学医院ICU。患者：接受机械通气的成人患者。干预：一种自动化应用程序，包括1）基于网络的仪表板，其中包含关于自主呼吸试验准备、镇静深度、镇静剂输注的实时数据，以及轻推解除镇静和清醒支持，以及2）一旦患者满足自主呼吸试验和自主觉醒试验的标准，则短信警报。在多学科会议期间，每天对干预前、镇静最小化和呼吸机释放进行审查。干预后，仪表板被用于多学科的拥挤，整个白天由呼吸治疗师，文本警报被发送到床边providers.MEASUREMENTS和主要结果：我们招募了115名受试者的概念验证研究。自主呼吸试验警报准确（98.3%），通常在患者接受强制通气时发送（88.5%），61.9%的患者同时收到自主觉醒试验警报。我们在前后研究中招募了457名受试者，其中221名为干预前，236名为干预后。实施后，在任何时间点，患者拔管的可能性增加28%（风险比，1.28; 95% CI，1.01-1.63; p = 0.042），从ICU出院的可能性增加31%（风险比，1.31; 95% CI，1.03-1.67; p = 0.027）。实施后机械通气时间中位数为2.20天（95%CI，0.09-4.31天; p = 0.042）更短，中位ICU住院时间为2.65天（95%CI，0.13-5.16 d; p = 0.040）短于未应用的预期持续时间。实施电子仪表板和警报系统，促进镇静最小化和呼吸机解放与减少机械通气的持续时间和ICU住院时间相关。
Sedation minimization and ventilator liberation protocols improve outcomes but are challenging to implement. We sought to demonstrate proof-of-concept and impact of an electronic application promoting sedation minimization and ventilator liberation.DESIGN: Multi-ICU proof-of-concept study and a single ICU before-after study.SETTING: University hospital ICUs.PATIENTS: Adult patients receiving mechanical ventilation.INTERVENTIONS: An automated application consisting of 1) a web-based dashboard with real-time data on spontaneous breathing trial readiness, sedation depth, sedative infusions, and nudges to wean sedation and ventilatory support and 2) text-message alerts once patients met criteria for a spontaneous breathing trial and spontaneous awakening trial. Pre-intervention, sedation minimization, and ventilator liberation were reviewed daily during a multidisciplinary huddle. Post-intervention, the dashboard was used during the multidisciplinary huddle, throughout the day by respiratory therapists, and text alerts were sent to bedside providers.MEASUREMENTS AND MAIN RESULTS: We enrolled 115 subjects in the proof-of-concept study. Spontaneous breathing trial alerts were accurate (98.3%), usually sent while patients were receiving mandatory ventilation (88.5%), and 61.9% of patients received concurrent spontaneous awakening trial alerts. We enrolled 457 subjects in the before-after study, 221 pre-intervention and 236 post-intervention. After implementation, patients were 28% more likely to be extubated (hazard ratio, 1.28; 95% CI, 1.01-1.63; p = 0.042) and 31% more likely to be discharged from the ICU (hazard ratio, 1.31; 95% CI, 1.03-1.67; p = 0.027) at any time point. After implementation, the median duration of mechanical ventilation was 2.20 days (95% CI, 0.09-4.31 d; p = 0.042) shorter and the median ICU length of stay was 2.65 days (95% CI, 0.13-5.16 d; p = 0.040) shorter, compared with the expected durations without the application.CONCLUSIONS: Implementation of an electronic dashboard and alert system promoting sedation minimization and ventilator liberation was associated with reductions in the duration of mechanical ventilation and ICU length of stay.