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)支持同等患者状态的可复制的、基于证据的决策。重症监护病房(ICU)的计算机协议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的大小和规模(粒度)相关的变化，这些变化需要修改为成人重症监护开发的呼吸机管理方案(“成人方案”)，以用于儿科实践。成人方案被选为我们儿科计算机方案的基础，因为方案的依从性很高，而且它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。这项研究是在技术接受和使用的统一理论(33)的指导下进行的，重点是计算机协议内容(患者数据、协议规则和建议)。具体地说，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的呼吸机管理决策，当决策不受计算机规程(社会规范)的指导时；并使用基于网络的问卷和临床场景来评估儿科重症监护提供者接受计算机规程推荐的呼吸机管理决策的潜在水平(性能预期)。这项研究有一个多PI领导计划，该计划利用PI的互补技能；并利用现有的协作性儿科危重护理研究网络(CPCCRN)基础设施。CPCCRN调查人员是经验丰富的儿科重症医生和研究人员，并支持这项研究。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的基础设施，为这项特殊的研究提供了强大的环境。这项拟议的研究解决了使用呼吸机的儿童的临床护理以及跨PICU的医生实践的可变性，目的是使这些实践标准化。将CDS纳入研究是一种创新的方法，可以支持对危重儿童进行有意义的干预性研究，这可能会改善结果。我们的最终目标将是在儿科ALI/ARDS中开展一项儿科常用的不同肺保护性通风模式的研究，使用计算机协议来标准化跨从业者和现场的呼吸机管理决策。来自单一机构的初步数据支持研究假设，但需要在多个机构进行验证，以确定使用CDS工具支持CPCCRN研究项目的可行性。这样一种经过测试、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风的儿童的护理。 公共卫生相关性：拟议的项目审查了儿科重症监护医生如何为急性低氧性呼吸衰竭(如急性肺损伤或急性呼吸窘迫综合征)患者做出呼吸机管理的决定。这项研究建议使用决策支持工具作为一种创新的方法，以支持临床医生关于儿科ICU呼吸机管理的可复制的、基于证据的决策。这些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。

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.