Implementation of Computerized Clinical Support for Mechanical Ventilation of Patients with Acute Respiratory Distress Syndrome

急性呼吸窘迫综合征机械通气计算机化临床支持的实施

• 批准号: 9764477
• 负责人: Colin Kerst Grissom
• 金额: $ 53.71万
• 依托单位: IHC HEALTH SERVICES, INC.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9764477
• 关键词: Accident and Emergency department; Acute respiratory failure; Adherence; Adopted; Adult Respiratory Distress Syndrome; Body Weight; Breathing; Caring; Characteristics; Clinical; Clinical Practice Guideline; Clinical effectiveness; Computerized Medical Record; Data; Development; Diffuse; Effectiveness; Environmental air flow; Evidence based practice; Future; Gases; Goals; Health Care Costs; Healthcare; Healthcare Systems; Hospital Administrators; Hospitals; Hybrids; Impairment; Injury; Inpatients; Intensive Care Units; Intervention; Left; Lung; Measures; Mechanical ventilation; Mechanics; Methods; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Nurses; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Penetration; Perception; Physicians; Pneumonia; Preparation; Process Measure; Protocols documentation; Research; Research Personnel; Sepsis; System; Testing; Tidal Volume; Time; Trauma; United States National Institutes of Health; Ventilator; Ventilator-induced lung injury; Weaning; adverse outcome; base; care delivery; clinical care; clinical decision support; clinical practice; cohort; computerized; design; effectiveness trial; electronic data; evidence based guidelines; implementation research; implementation science; implementation strategy; implementation trial; improved; lung injury; mortality; respiratory; support tools; tool

Project Summary/Abstract Acute respiratory distress syndrome (ARDS) is a diffuse lung injury resulting in impaired gas exchange and patients require mechanical ventilation for support. ARDS is associated with very high morbidity, mortality, and healthcare cost. The approach to mechanical ventilation in patients with ARDS matters substantially. Lung protective low tidal volume ventilation (LTVV) is associated with the best patient outcomes. Despite overwhelming evidence that lung protective LTVV is the preferred approach to mechanical ventilation in patients with ARDS, too many patients with ARDS do not receive it. The goal of the proposed research is to pair clinical effectiveness researchers with implementation science researchers in order to conduct a study to determine barriers and facilitators to best evidence-based practices for mechanical ventilation of patients with ARDS. After barriers and facilitators to implementation of lung protective LTVV in patients with ARDS are determined, this proposed research will develop strategies for interventions to improve compliance. Intermountain Healthcare has created a computerized clinical decision support tool for lung protective mechanical ventilation. This tool has been deployed at 12 Intermountain Healthcare hospitals with 17 intensive care units for management of all patients with acute respiratory failure requiring mechanical ventilation. This lung protective LTVV clinical decision support tool has been deployed for use in all mechanically ventilated patients and left up to physician discretion to implement. The strongest evidence for lung protective LTVV is in patients with ARDS. The focus of this proposed study will be to characterize the group of patients with ARDS among mechanically ventilated patients at Intermountain Healthcare and determine strategies to improve compliance with lung protective LTVV in those patients using the computerized electronic decision support tool. In the brief time of implementation, utilization of the computerized clinical decision support tool for mechanically ventilated patients has been highly variable. Creation of a clinical decision support tool alone is unlikely to change clinical practice of adopting LTVV. This proposed study will focus on implementation of lung protective LTVV in patients with ARDS at Intermountain Healthcare hospitals using the clinical decision support tool. Barriers and facilitators associated with implementation of the lung-protective computerized mechanical ventilation clinical decision support for patients with ARDS will be identified. The Consolidated Framework for Implementation Research will be used to guide development of a ventilation protocol implementation strategy that will be tested during a subsequent hybrid effectiveness-implementation trial. The specific aims of this proposed study are to characterize the baseline characteristics of patients with ARDS at Intermountain Healthcare hospitals and assess barriers and facilitators to ideal clinical care delivery of LTVV and then to derive and test an implementation plan for feasibility to achieve LTVV for all patients with ARDS.

项目总结/文摘

项目成果

Increasing Adherence to Evidence-Based Care Using Root Cause Analysis.

使用根本原因分析提高循证护理的依从性。

• DOI: 10.1097/qmh.0000000000000270
• 发表时间: 2020
• 期刊: Quality management in health care
• 影响因子: 1.2
• 作者: Allen,Lauren;Knighton,AndrewJ;Brunisholz,KimberlyD;Wolfe,Doug;Kean,Jacob;Belnap,ThomasW;Grissom,Colin;Srivastava,Raj
• 通讯作者: Srivastava,Raj

An alert tool to promote lung protective ventilation for possible acute respiratory distress syndrome.

• DOI: 10.1093/jamiaopen/ooac050
• 发表时间: 2022-07
• 期刊: JAMIA OPEN
• 影响因子: 2.1
• 作者: Knighton, Andrew J.;Kuttler, Kathryn G.;Ranade-Kharkar, Pallavi;Allen, Lauren;Throne, Taylor;Jacobs, Jason R.;Carpenter, Lori;Winberg, Carrie;Johnson, Kyle;Shrestha, Neer;Ferraro, Jeffrey P.;Wolfe, Doug;Peltan, Ithan D.;Srivastava, Rajendu;Grissom, Colin K.
• 通讯作者: Grissom, Colin K.

Delivery of Lung-protective Ventilation for Acute Respiratory Distress Syndrome: A Hybrid Implementation-Effectiveness Trial.

为急性呼吸窘迫综合征提供肺保护性通气：一项混合实施-有效性试验。

• DOI: 10.1513/annalsats.202207-626oc
• 发表时间: 2023
• 期刊: Annals of the American Thoracic Society
• 影响因子: 8.3
• 作者: Peltan,IthanD;Knighton,AndrewJ;Barney,BradleyJ;Wolfe,Doug;Jacobs,JasonR;Klippel,Carolyn;Allen,Lauren;Lanspa,MichaelJ;Leither,LindsayM;Brown,SamuelM;Srivastava,Rajendu;Grissom,ColinK
• 通讯作者: Grissom,ColinK

Implementation of Lung-Protective Ventilation in Patients With Acute Respiratory Failure.

对急性呼吸衰竭患者实施肺保护性通气。

• DOI: 10.1097/ccm.0000000000005840
• 发表时间: 2023
• 期刊: Critical care medicine
• 影响因子: 8.8
• 作者: Grissom,ColinK;Lanspa,MichaelJ;Groat,Danielle;Jacobs,JasonR;Carpenter,Lori;Kuttler,KathrynG;Leither,Lindsay;Peltan,IthanD;Brown,SamuelM;Srivastava,Rajendu
• 通讯作者: Srivastava,Rajendu