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

描述（由申请人提供）：需要长时间机械通气的严重急性呼吸衰竭（ARF）是医院中最常见的急性器官功能障碍形式，通常与多器官衰竭（MOF）、高死亡率和功能障碍相关。 损伤大多数关于ARF的研究都集中在重症监护室（ICU）的患者，他们已经接受了数天的机械通气，并且已经确定了终末器官损伤。该项目的总体目标是改善ICU内外发生严重ARF和长期机械通气的高风险患者的结局。该项目旨在通过基于电子病历（EMR）的、以患者为中心的常见重症监护实践清单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（预防器官衰竭清单- PROOFcheck）。本申请提出了一项阶梯楔形、分组随机对照试验，以确定PROOFcheck在确定为进展为重度ARF和延长机械通气的高风险患者中改善生存率和缩短机械通气和多器官衰竭持续时间的效用。UH 2阶段的目标是：1）将先前验证的肺损伤预测评分细化为实用的、基于EMR的早期预测模型，以准确预测延长通气（APPROVE），其将自动识别医院中任何地方的处于发展需要机械通气>48小时的严重ARF的高风险的患者; 2）将PROOFcheck纳入EMR，以提示临床医生在护理实践中限制肺损伤，预防不良事件，并避免额外的器官衰竭; 3）为拟议的试验建立基础设施。拟议的务实试验将利用全院范围的EMR来识别使用APPROVE进行长期机械通气的高风险患者，以便使用PROOFcheck进行干预。因此，拟议的试验旨在打破目前在医院组织护理的临床孤岛，并在患者病情需要时随时随地为急性病患者提供以患者为中心的适当护理。

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.