Translating an Adult Ventilator Computer Protocol to Pediatric Critical Care

将成人呼吸机计算机协议应用于儿科重症监护

基本信息

项目摘要

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.
描述(由申请人提供):计算机决策支持工具(计算机协议)支持针对同等患者状态的可复制、基于证据的决策。重症监护病房 (ICU) 计算机协议的研究主要集中在成人 ICU。拟议研究的总体目标是调查与适当大小和规模(粒度)相关的变化,这些变化是修改呼吸机管理方案所需的,该方案是为成人重症监护(“成人方案”)和儿科实践而制定的。选择成人方案作为我们儿科计算机方案的基础,因为该方案的遵守率很高,并且对机械通气实践有很大影响;然而,成人研究结果对儿科的适用性尚未确定。该研究以技术接受和使用统一理论 (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)。具体来说,我们计划使用 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的呼吸机管理决策,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调查和临床场景来评估儿科重症监护提供者接受计算机方案推荐的呼吸机管理决策的潜在水平(性能预期)。该研究有一个多 PI 领导计划,利用 PI 的互补技能;并利用现有的儿科重症监护协作研究网络 (CPCCRN) 基础设施。 CPCCRN 的研究人员是经验丰富的儿科重症医生和研究人员,他们支持这项研究。他们的承诺、大型临床站点和稳定的网络基础设施(包括 CPCCRN 数据协调中心)为这项特殊研究提供了强大的环境。这项拟议的研究涉及使用呼吸机的儿童的临床护理以及各个 PICU 医生实践的差异,旨在标准化这些实践。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通气模式进行儿科 ALI/ARDS 的研究,使用计算机协议标准化从业人员和场所的呼吸机管理决策。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、被接受的方案也应该对变异性产生有益的影响,并改善对所有需要机械通气的儿童的护理。 公共健康相关性:拟议项目研究儿科重症监护医生如何对急性低氧性呼吸衰竭(急性肺损伤或急性呼吸窘迫综合征等病症)患者的呼吸机管理做出决策。该研究建议使用决策支持工具作为一种创新方法,支持临床医生关于儿科 ICU 呼吸机管理的可复制、循证决策。此类工具的最终目的是支持研究和临床实践,从而提高 PICU 医疗护理的质量。

项目成果

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CHRISTOPHER JOHN NEWTH其他文献

CHRISTOPHER JOHN NEWTH的其他文献

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{{ truncateString('CHRISTOPHER JOHN NEWTH', 18)}}的其他基金

Translating an Adult Ventilator Computer Protocol to Pediatric Critical Care
将成人呼吸机计算机协议应用于儿科重症监护
  • 批准号:
    8234964
  • 财政年份:
    2011
  • 资助金额:
    $ 25.22万
  • 项目类别:
Physiologically Guided Ventilator Strategies in Children
生理引导儿童呼吸机策略
  • 批准号:
    7174870
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Physiologically Guided Ventilator Strategies in Children
生理引导儿童呼吸机策略
  • 批准号:
    7546558
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Controlled Trial of Two Lung Protective Ventilation Modes in Acute Lung Injury
两种肺保护性通气模式在急性肺损伤中的对照试验
  • 批准号:
    8010140
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Physiologically Guided Ventilator Strategies in Children
生理引导儿童呼吸机策略
  • 批准号:
    6938924
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Controlled Trial of Two Lung Protective Ventilation Modes in Acute Lung Injury
两种肺保护性通气模式在急性肺损伤中的对照试验
  • 批准号:
    8204667
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Los Angeles Center of the Collaborative Pediatric Critical Care Research Network
洛杉矶儿科重症监护协作研究网络中心
  • 批准号:
    8854802
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Physiologically Guided Ventilator Strategies in Children
生理引导儿童呼吸机策略
  • 批准号:
    7355603
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Physiologically Guided Ventilator Strategies in Children
生理引导儿童呼吸机策略
  • 批准号:
    7060875
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:
Controlled Trial of Two Lung Protective Ventilation Modes in Acute Lung Injury
两种肺保护性通气模式在急性肺损伤中的对照试验
  • 批准号:
    8401904
  • 财政年份:
    2005
  • 资助金额:
    $ 25.22万
  • 项目类别:

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