权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Educational strategies to promote post-extubation non-invasive ventilation in patients with acute respiratory failure

促进急性呼吸衰竭患者拔管后无创通气的教育策略

基本信息

批准号：
9764479
负责人：
Timothy D Girard
金额：
$ 51.87万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-15 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9764479
关键词：
Acute respiratory failure Adoption Adult Blood Breathing Cessation of life Clinical Clinical Practice Guideline Clinical Trials Critical Care Critical Illness Data Disease Education Educational Intervention Effectiveness Environmental air flow Evidence based practice Eye Failure Focus Groups Foundations Health system Healthcare Heart Hospitals Hour Hybrids Inpatients Interruption Interview Knowledge Lead Learning Life Lung Measures Mechanical ventilation Medical Care Team Morbidity - disease rate Multi-Institutional Clinical Trial Nature Outcome Patients Persons Preparation Protocols documentation Provider Randomized Controlled Trials Recommendation Recurrence Research Infrastructure Respiratory Failure Risk Role Series Site Sleep Speed Testing Time Transcript Tube United States Work arm base behavior change continuing medical education design experience face mask high risk implementation research implementation strategy implementation trial improved improved outcome innovation instrument learned behavior learning strategy mortality novel novel strategies response theories

项目摘要

PROJECT SUMMARY Nearly 800,000 patients require invasive mechanical ventilation for acute respiratory failure in the United States each year. Among those who recover to the point of extubation, a substantial proportion remain at high risk for extubation failure, i.e., recurrent respiratory failure requiring reintubation within 48 hours of extubation. For these vulnerable patients, extubation directly to noninvasive ventilation reduces the risk of recurrent respiratory failure, reintubation, and death. Based on evidence from multiple randomized controlled trials, post- extubation noninvasive ventilation among high-risk patients is strongly recommended in recent clinical practice guidelines. Yet, despite these recommendations, the use of this evidence-based practice remains limited, leading to preventable morbidity and mortality. Our long-term objective is to conduct a multicenter, hybrid effectiveness-implementation trial to identify the optimal strategy for promoting the use of post-extubation noninvasive ventilation among high-risk patients recovering from acute respiratory failure. In this application, we propose a series of studies that will culminate in our ability to successfully conduct this trial. Specifically, we plan to achieve the following aims: (1) qualitatively assess barriers and facilitators to the adoption of post- extubation noninvasive ventilation and evaluate the role of educational interventions in improving adoption; (2) develop and pilot test three strategies designed to speed implementation of post-extubation noninvasive ventilation: one control strategy (traditional online continuing medical education) and two novel strategies (interprofessional education and just-in-time education); and (3) finalize preparations for a four-arm, multicenter, hybrid effectiveness-implementation trial conducted within the UPMC Health System to identify the implementation strategy that best promotes use of post-extubation noninvasive ventilation, comparing control with interprofessional education, just-in-time education, and both. This work is important because it will lead directly to a major clinical trial with the potential to improve outcomes for hundreds of thousands of high-risk patients with acute respiratory failure, and it will provide foundational knowledge about the roles of interprofessional education and just-in-time education as implementation strategies in the hospital setting. This work is innovative because it is based on novel theories for organizational learning and behavior change that account for the interprofessional nature of critical care and the unique needs of the adult learner. This work is feasible in our hands because it builds off an existing research infrastructure developed by an accomplished study team with extensive experience conducting both implementation research and multicenter clinical trials in critically ill patients.

项目摘要美国近80万例急性呼吸衰竭患者需要有创机械通气每年的国家。在那些恢复到拔管点的人中，很大一部分人仍然在拔管失败的高风险，即，复发性呼吸衰竭，需要在48小时内重新插管拔管对于这些脆弱的患者，拔管直接无创通气可降低风险反复呼吸衰竭再插管和死亡基于来自多个随机对照试验，拔管后无创通气在高危患者中强烈在最近的临床实践指南中推荐。然而，尽管有这些建议，循证做法仍然有限，导致可预防的发病率和死亡率。我们的长期目的是进行一项多中心、混合有效性-实施试验，以确定最佳的在高危患者中推广拔管后无创通气的策略正在从急性呼吸衰竭中恢复在本申请中，我们提出了一系列研究，最终让我们有能力成功进行这次审判具体来说，我们计划实现以下目标目的：（1）定性评估采用拔管后无创性的障碍和促进因素通风和评估教育干预措施在改善收养方面的作用;（2）开发和试点测试三种旨在加速实施拔管后无创通气的策略：控制策略（传统的在线继续医学教育）和两个新的策略（跨专业教育和及时教育）;（3）完成四臂，在UPMC卫生系统内进行的多中心混合有效性实施试验，确定最能促进拔管后无创通气使用的实施策略，比较控制与跨专业教育，即时教育，以及两者兼而有之。这项工作是重要的是，它将直接导致一项重大的临床试验，有可能改善成千上万的高危急性呼吸衰竭患者，它将提供基础了解跨专业教育和及时教育作为实施的作用，在医院环境中的战略。这项工作是创新的，因为它是基于新的理论，组织学习和行为改变，解释了重症监护的跨专业性质和成人学习者的独特需求。这项工作在我们手中是可行的，因为它建立在一个现有的研究基础设施由一个经验丰富的研究团队开发在危重患者中开展实施研究和多中心临床试验。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Enhancing Implementation of Complex Critical Care Interventions through Interprofessional Education.

DOI：
10.34197/ats-scholar.2020-0169oc
发表时间：
2021-09
期刊：
ATS scholar
影响因子：
1.9
作者：
Rak KJ;Kahn JM;Linstrum K;Caplan EA;Argote L;Barnes B;Chang CH;George EL;Hess DR;Russell JL;Seaman JB;Angus DC;Girard TD
通讯作者：
Girard TD

Provider Perspectives on Preventive Postextubation Noninvasive Ventilation for High-Risk Intensive Care Unit Patients.

提供者对高危重症监护病房患者预防性拔管后无创通气的看法。