Prevention of Severe Acute Respiratory Failure in Patients with PROOFCheck - an E

项目摘要 需要长时间机械通气的严重急性呼吸衰竭（ARF）是最常见的 急性器官功能障碍是医院中常见的一种形式，通常与多种 器官衰竭（MOF）、高死亡率和功能损害。大多数关于ARF的研究 专注于重症监护室（ICU）中的患者，他们已经接受了机械治疗， 已经有数天的通气和终末器官损伤。这个项目的总体目标是 一个被提议的项目是改善发展为严重ARF的高风险患者的预后 以及重症监护室内外长时间的机械通气该项目旨在干预 早期以高危患者电子病历（EMR）为基础，以患者为中心 旨在预防肺损伤和医院获得性肺损伤的常见重症监护实践清单 通常导致器官衰竭的不良事件（预防器官衰竭检查表- PROOFcheck）。本申请提出了一个阶梯楔形，集群随机对照试验 确定PROOFcheck在提高生存率和缩短持续时间方面的效用 机械通气和多器官功能衰竭的高风险患者 进展为严重急性肾衰竭和长时间机械通气。UH 2阶段的目标 是：1）将先前验证的肺损伤预测评分细化为实用的EMR- 基于早期预测模型准确预测延长通气（APPROVE）， 将自动识别医院内任何地方的高风险患者， 需要机械通气>48小时的重度ARF; 2）将PROOFcheck纳入 EMR提示临床医生在护理实践中限制肺损伤，预防不良事件， 避免额外的器官衰竭; 3）为拟议的试验建立基础设施。的 拟议的务实试验将利用医院范围内的EMR来识别高风险患者， 使用PROOFcheck进行干预的APPROVE延长机械通气。因此，在本发明中， 拟议的试验旨在打破目前组织医疗的临床孤岛， 医院，并为急性病患者提供以患者为中心的，适当的护理 无论何时何地，只要病人的病情需要

PROJECT SUMMARY Severe acute respiratory failure (ARF) requiring prolonged mechanical ventilation is the most common form of acute organ dysfunction in the hospital, and is often associated with multiple organ failure (MOF), high mortality, and functional impairment. Most studies on ARF have focused on patients in the intensive care unit (ICU) after they have been on mechanical ventilation for days and end organ damage is already established. The overall goal of this proposed project is to improve the outcomes of patients at high risk for developing severe ARF and prolonged mechanical ventilation in and outside of the ICU. The project aims to intervene early in high risk patients with an electronic medical records (EMR)-based, patient-centered checklist of common critical care practices aimed at preventing lung injury and hospital acquired adverse events that commonly lead to organ failure (Prevention of Organ Failure checklist - PROOFcheck). This application proposes a stepped-wedge, clustered randomized control trial to determine the utility of PROOFcheck to improve survival and reduce the duration of mechanical ventilation and multiple organ failure in patients identified as high risk for progressing to severe ARF and prolonged mechanical ventilation. The aims in the UH2 phase are: 1) to refine a previously validated Lung Injury Prediction Score into a pragmatic, EMR- based early prediction model to Accurately Predict Prolonged Ventilation (APPROVE), which will automatically identify patients anywhere in the hospital who are at high risk for developing severe ARF requiring mechanical ventilation >48 hours; 2) to incorporate PROOFcheck into the EMR to prompt clinicians on care practices to limit lung injury, prevent adverse events, and avoid additional organ failure; and 3) to establish the infrastructure for the proposed trial. The proposed pragmatic trial will harness the hospital-wide EMR to identify patients at high risk for prolonged mechanical ventilation with APPROVE for intervention with PROOFcheck. As such, the proposed trial aims to break out of the clinical silos by which care is currently organized in the hospital and bring patient-centered, context appropriate care to the acutely ill patient wherever and whenever the patient's condition requires it.