Prevention of Severe Acute Respiratory Failure in Patients with PROOFCheck - an E

描述(由申请人提供)：严重急性呼吸衰竭(ARF)需要长时间的机械通气，是医院最常见的急性器官功能障碍形式，通常与多器官衰竭(MOF)、高死亡率和功能性 减损。大多数关于ARF的研究都集中在重症监护病房(ICU)的患者，他们已经接受了几天的机械通气，并且器官损伤已经结束。这一拟议项目的总体目标是改善重症急性呼吸衰竭和ICU内外长时间机械通气的高危患者的预后。该项目旨在通过基于电子病历(EMR)、以患者为中心的常见危重护理做法核对表对高危患者进行早期干预，旨在预防肺损伤和通常导致器官衰竭的医院获得性不良事件(预防器官衰竭核对表-PROOFcheck)。这项申请提出了一项阶梯式楔形分组随机对照试验，以确定PROOFcheck在提高存活率、缩短机械通气持续时间和多器官衰竭方面的有效性，这些患者被认为是进展为严重ARF和机械通气时间延长的高风险患者。UH2阶段的目标是：1)将先前经过验证的肺损伤预测评分改进为实用的、基于EMR的早期预测模型，以准确预测长时间的机械通气(APPROVE)，该模型将自动识别医院内任何地方有患严重ARF需要机械通风48小时的高风险患者；2)将PROOFcheck纳入EMR，以提示临床医生进行护理实践，以限制肺损伤、防止不良事件和避免额外的器官衰竭；以及3)为拟议的试验建立基础设施。拟议的务实试验将利用医院范围的EMR来识别长期机械通气的高危患者，并批准使用PROOFCheck进行干预。因此，拟议的试验旨在打破目前医院组织护理的临床孤岛，随时随地为危重患者带来以患者为中心的、适当的上下文护理。

DESCRIPTION (provided by applicant): Severe acute respiratory failure (ARF) requiring prolonged mechanical ventilation is the most common form of acute organ dysfunction in the hospital, and is often associated with multiple organ failure (MOF), high mortality, and functional impairment. Most studies on ARF have focused on patients in the intensive care unit (ICU) after they have been on mechanical ventilation for days and end organ damage is already established. The overall goal of this proposed project is to improve the outcomes of patients at high risk for developing severe ARF and prolonged mechanical ventilation in and outside of the ICU. The project aims to intervene early in high risk patients with an electronic medical records (EMR)-based, patient-centered checklist of common critical care practices aimed at preventing lung injury and hospital acquired adverse events that commonly lead to organ failure (Prevention of Organ Failure checklist - PROOFcheck). This application proposes a stepped-wedge, clustered randomized control trial to determine the utility of PROOFcheck to improve survival and reduce the duration of mechanical ventilation and multiple organ failure in patients identified as high risk for progressing to severe ARF and prolonged mechanical ventilation. The aims in the UH2 phase are: 1) to refine a previously validated Lung Injury Prediction Score into a pragmatic, EMR- based early prediction model to Accurately Predict Prolonged Ventilation (APPROVE), which will automatically identify patients anywhere in the hospital who are at high risk for developing severe ARF requiring mechanical ventilation >48 hours; 2) to incorporate PROOFcheck into the EMR to prompt clinicians on care practices to limit lung injury, prevent adverse events, and avoid additional organ failure; and 3) to establish the infrastructure for the proposed trial. The proposed pragmatic trial will harness the hospital-wide EMR to identify patients at high risk for prolonged mechanical ventilation with APPROVE for intervention with PROOFcheck. As such, the proposed trial aims to break out of the clinical silos by which care is currently organized in the hospital and bring patient-centered, context appropriate care to the acutely ill patient wherever and whenever the patient's condition requires it.