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

项目总结 需要长期机械通气的严重急性呼吸衰竭(ARF)是最常见的 医院中常见的急性器官功能障碍，常与多发性 器官衰竭(MOF)、高死亡率和功能障碍。大多数关于ARF的研究都有 重点关注重症监护病房(ICU)的患者在接受机械治疗后 几天的通风和结束器官损伤已经建立起来了。这个项目的总体目标是 建议的项目是改善严重急性肾衰高危患者的预后 以及ICU内外长时间的机械通气。该项目旨在干预 早期高危患者以电子病历(EMR)为基础，以患者为中心 旨在预防肺损伤和医院获得的常见危重护理做法核对表 通常导致器官衰竭的不良事件(预防器官衰竭清单- PROOFCheck)。这项申请提出了一项阶梯楔形、整群随机对照试验 确定PROOFCheck在提高存活率和缩短持续时间方面的效用 高危患者的机械通气和多器官功能衰竭 进展为严重的ARF和长时间的机械通气。UH2阶段的目标 1)将先前验证的肺损伤预测评分提炼为实用的EMR- 基于早期预测模型，准确预测延长通气量(Approval)， 将自动识别医院中任何位置的高危患者 严重ARF需要机械通风；48小时；2)将PROOFCheck纳入 电子病历提示临床医生进行护理实践，以限制肺损伤，防止不良事件，以及 避免额外的器官衰竭；以及3)为拟议的试验建立基础设施。这个 拟议的务实试验将利用医院范围的EMR来识别高危患者 延长机械通气时间，批准对PROOFCheck进行干预。因此， 这项拟议的试验旨在打破目前组织护理的临床孤岛 医院，并为危重患者带来以患者为中心的、上下文适当的护理 无论何时何地，只要病人的情况需要。

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.