Translating an Adult Ventilator Computer Protocol to Pediatric Critical Care

描述（由申请人提供）：计算机决策支持工具（计算机协议）支持对等效患者状态进行可复制的、基于证据的决策。计算机协议在重症监护病房（ICU）的研究主要集中在成人ICU。拟议研究的总体目标是调查修改呼吸机管理方案所需的适当大小和规模（粒度）的变化，该方案是为成人重症监护（“成人方案”）制定的，适用于儿科实践。我们选择成人方案作为儿科计算机方案的基础，因为对方案的依从性很高，它对机械通气实践有很大的影响；然而，成人研究结果是否适用于儿科还有待确定。本研究以技术接受与使用统一理论（33）为指导，重点关注计算机协议内容（患者数据、协议规则和建议）。具体而言，我们计划使用来自ALI或ARDS患者的前瞻性观察数据来评估儿科重症监护环境中呼吸机管理决策，当决策不受计算机协议（社会规范）指导时；并使用基于网络的问卷和临床场景来评估儿科危重病护理提供者接受计算机协议推荐的呼吸机管理决策的潜在水平（预期性能）。该研究有一个多重PI领导计划，利用PI的互补技能；并利用现有的儿科重症护理研究合作网络（CPCCRN）基础设施。CPCCRN的研究人员是经验丰富的儿科重症医师和研究人员，他们支持这项研究。他们的承诺，大型临床站点和包括CPCCRN数据协调中心在内的网络稳定基础设施，为这项特殊研究提供了强大的环境。本研究旨在探讨使用呼吸机的儿童的临床护理，以及picu中医生实践的差异，旨在使这些实践标准化。将CDS纳入研究是一种创新方法，可以支持对危重儿童进行有意义的干预性研究，从而改善结果。我们的最终目标是对儿科常用的不同肺保护性通气模式的儿童ALI/ARDS进行研究，使用计算机协议来标准化不同医生和地点的呼吸机管理决策。来自单个机构的初步数据支持研究假设，但需要在多个机构之间进行验证，以确定使用CDS工具支持CPCCRN研究项目的可行性。这样一个经过测试的、被接受的方案也应该对可变性产生有益的影响，并改善对所有需要机械通气的儿童的护理。

DESCRIPTION (provided by applicant): Computer decision support tools (computer protocols) support replicable, evidence-based decisions for equivalent patient states. Research on computer protocols in the intensive care unit (ICU) has primarily been focused on adult ICUs. The overall goal of the proposed research is to investigate the changes related to appropriate size and scale (granularity) that are required to modify a ventilator management protocol, developed for adult critical care ("adult protocol"), for pediatric practice. The adult protocol was chosen as the basis for our pediatric computer protocol because adherence to the protocol was high and it had a large impact on mechanical ventilation practices; however the applicability of the adult findings to pediatrics has yet to be established. The study is guided by the Unified Theory of Acceptance and Use of Technology (33), with focus on the computer protocol content (patient data, protocol rules, and recommendations). Specifically, we plan to use prospective observational data from patients with ALI or ARDS to evaluate ventilator management decisions in the pediatric critical care environment, when decisions are not guided by a computer protocol (social norms); and to use a web-based questionnaire with clinical scenarios to evaluate the potential level at which pediatric critical care providers would accept ventilator management decisions recommended by a computer protocol (performance expectancy). The study has a multiple PI leadership plan that capitalizes on the complementary skills of the PIs; and takes advantage of existing Collaborative Pediatric Critical Care Research Network (CPCCRN) infrastructure. CPCCRN investigators are experienced pediatric intensivists and researchers and support this study. Their commitment, large clinical sites and the stable infrastructure of the Network including the CPCCRN Data Coordinating Center, provide a strong environment for this particular study. This proposed study addresses the clinical care of children on ventilators and the variability in physician practice across PICUs with the aim of standardizing these practices. Incorporation of CDS within research is an innovative methodology that can support meaningful interventional research studies in critically ill children, which could improve outcomes. Our ultimate goal will be to undertake a study in pediatric ALI/ARDS of different modes of lung protective ventilation commonly used in pediatrics, using the computer protocol to standardize ventilator management decisions across practitioners and sites. Preliminary data from a single institution support the study hypotheses but need to be validated across multiple institutions to determine the feasibility of using a CDS tool to support research projects in the CPCCRN. Such a tested, accepted protocol should also have a beneficial effect on variability and improve care for all children requiring mechanical ventilation. PUBLIC HEALTH RELEVANCE: The proposed project examines how pediatric intensive care physicians make decisions about ventilator management for patients with acute hypoxemic respiratory failure (conditions such as acute lung injury or acute respiratory distress syndrome). The study suggests use of decision support tools as an innovative methodology to support replicable, evidence-based clinician decisions regarding ventilator management in the pediatric ICU. The ultimate aim of such tools is to support research and clinical practices that would, in turn, improve the quality of PICU medical care.