Implementation of Computerized Clinical Support for Mechanical Ventilation of Patients with Acute Respiratory Distress Syndrome

项目摘要/摘要 急性呼吸窘迫综合征(ARDS)是一种弥漫性肺损伤，导致气体交换和 患者需要机械通风来支持。急性呼吸窘迫综合征与很高的发病率、死亡率和 医疗保健成本。ARDS患者的机械通气方法非常重要。肺 保护性低潮气量通气(LTVV)与最佳患者预后相关。尽管 强有力的证据表明肺保护性LTVV是慢性阻塞性肺疾病患者机械通气的首选方法 ARDS患者，太多ARDS患者没有接受治疗。拟议研究的目标是 将临床有效性研究人员与实施科学研究人员配对，以便进行以下研究 确定机械通气患者最佳循证实践的障碍和促进者 阿兹。在ARDS患者实施肺保护性LTVV的障碍和促进剂之后 下定决心，这项拟议的研究将制定干预战略，以提高遵从性。 InterMountain Healthcare创建了一种用于肺保护的计算机化临床决策支持工具 机械通风。该工具已在12家山间医疗保健医院部署，17家重症医院 用于管理所有需要机械通气的急性呼吸衰竭患者的护理单元。这 肺保护性LTVV临床决策支持工具已部署用于所有机械通气 而让患者自行决定是否实施。肺保护性LTVV的最有力证据是 患有ARDS的患者。这项拟议的研究的重点将是确定ARDS患者的特征 山间医疗中心机械通气患者的健康状况，并确定改善策略 计算机化电子决策支持对肺保护性LTVV依从性的影响 工具。在实施的短暂时间内，利用计算机化的临床决策支持工具 机械通气的患者一直是高度可变的。创建一个临床决策支持工具本身就是 不太可能改变采用LTVV的临床实践。这项拟议的研究将集中在肺脏的实施上 临床决策支持在山间保健医院ARDS患者保护性LTVV中的应用 工具。与实施肺保护计算机化机械有关的障碍和促进者 将确定ARDS患者的呼吸机临床决策支持。综合框架，用于 将使用实施研究来指导制定通风方案实施战略 这将在随后的混合有效性实施试验中进行测试。这样做的具体目的是 建议的研究是描述山间ARDS患者的基线特征 并评估LTVV提供理想临床护理的障碍和促进者，然后 为所有ARDS患者实现LTVV的可行性导出并测试实施计划。

Project Summary/Abstract Acute respiratory distress syndrome (ARDS) is a diffuse lung injury resulting in impaired gas exchange and patients require mechanical ventilation for support. ARDS is associated with very high morbidity, mortality, and healthcare cost. The approach to mechanical ventilation in patients with ARDS matters substantially. Lung protective low tidal volume ventilation (LTVV) is associated with the best patient outcomes. Despite overwhelming evidence that lung protective LTVV is the preferred approach to mechanical ventilation in patients with ARDS, too many patients with ARDS do not receive it. The goal of the proposed research is to pair clinical effectiveness researchers with implementation science researchers in order to conduct a study to determine barriers and facilitators to best evidence-based practices for mechanical ventilation of patients with ARDS. After barriers and facilitators to implementation of lung protective LTVV in patients with ARDS are determined, this proposed research will develop strategies for interventions to improve compliance. Intermountain Healthcare has created a computerized clinical decision support tool for lung protective mechanical ventilation. This tool has been deployed at 12 Intermountain Healthcare hospitals with 17 intensive care units for management of all patients with acute respiratory failure requiring mechanical ventilation. This lung protective LTVV clinical decision support tool has been deployed for use in all mechanically ventilated patients and left up to physician discretion to implement. The strongest evidence for lung protective LTVV is in patients with ARDS. The focus of this proposed study will be to characterize the group of patients with ARDS among mechanically ventilated patients at Intermountain Healthcare and determine strategies to improve compliance with lung protective LTVV in those patients using the computerized electronic decision support tool. In the brief time of implementation, utilization of the computerized clinical decision support tool for mechanically ventilated patients has been highly variable. Creation of a clinical decision support tool alone is unlikely to change clinical practice of adopting LTVV. This proposed study will focus on implementation of lung protective LTVV in patients with ARDS at Intermountain Healthcare hospitals using the clinical decision support tool. Barriers and facilitators associated with implementation of the lung-protective computerized mechanical ventilation clinical decision support for patients with ARDS will be identified. The Consolidated Framework for Implementation Research will be used to guide development of a ventilation protocol implementation strategy that will be tested during a subsequent hybrid effectiveness-implementation trial. The specific aims of this proposed study are to characterize the baseline characteristics of patients with ARDS at Intermountain Healthcare hospitals and assess barriers and facilitators to ideal clinical care delivery of LTVV and then to derive and test an implementation plan for feasibility to achieve LTVV for all patients with ARDS.