Implementation of Lung Protective Ventilation in Patients With Acute Respiratory Failure
| Status: | Recruiting |
|---|---|
| Conditions: | Cardiology, Hospital, Pulmonary, Pulmonary |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Pulmonary / Respiratory Diseases, Other |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/12/2018 |
| Start Date: | March 2016 |
| End Date: | December 2019 |
| Contact: | Colin Grissom, MD |
| Email: | Colin.Grissom@imail.org |
| Phone: | 801-507-6554 |
This is a quality improvement study with the purpose of observing and measuring the effects
of implementation of a proven standardized lung protective ventilation protocol in the new
electronic medical record system iCentra across all Intermountain Healthcare hospitals.
Approximately 14,000 records will be accessed for this study from a database of mechanically
ventilated patients established for quality improvement purposes.
The investigators hypothesize that implementation of a standardized computerized lung
protective ventilation protocol across all Intermountain Healthcare hospitals will be
feasible, will decrease initial tidal volumes to the target 6 ml/kg PBW, and will improve
outcomes.
The objectives of this study are to:
- Determine if the implementation of lung protective ventilation (with a 6 ml/kg PBW tidal
volume ventilation protocol on initiation of mechanical ventilation) improves outcomes
in patients with acute respiratory failure requiring mechanical ventilation
- Determine if the implementation of lung protective ventilation (with a 6 ml/kg PBW tidal
volume ventilation protocol on initiation of mechanical ventilation) improves outcomes
in the sub-group of patients with the acute respiratory distress syndrome (ARDS)
- Measure compliance with the implementation of a computerized lung protective ventilation
protocol at 12 Intermountain Healthcare hospitals
of implementation of a proven standardized lung protective ventilation protocol in the new
electronic medical record system iCentra across all Intermountain Healthcare hospitals.
Approximately 14,000 records will be accessed for this study from a database of mechanically
ventilated patients established for quality improvement purposes.
The investigators hypothesize that implementation of a standardized computerized lung
protective ventilation protocol across all Intermountain Healthcare hospitals will be
feasible, will decrease initial tidal volumes to the target 6 ml/kg PBW, and will improve
outcomes.
The objectives of this study are to:
- Determine if the implementation of lung protective ventilation (with a 6 ml/kg PBW tidal
volume ventilation protocol on initiation of mechanical ventilation) improves outcomes
in patients with acute respiratory failure requiring mechanical ventilation
- Determine if the implementation of lung protective ventilation (with a 6 ml/kg PBW tidal
volume ventilation protocol on initiation of mechanical ventilation) improves outcomes
in the sub-group of patients with the acute respiratory distress syndrome (ARDS)
- Measure compliance with the implementation of a computerized lung protective ventilation
protocol at 12 Intermountain Healthcare hospitals
Study Design:
This is an observational quality improvement study comparing outcomes before, and after,
implementation of a proven lung protective ventilation protocol in an electronic medical
record system, iCentra, that will be implemented in phases across Intermountain Healthcare
hospitals. A phased implementation with a two-month washout period will be used to evaluate
the primary outcome of interest, ventilator free days (VFDs) to 28 days. Secondary outcomes
will include: use of the protocol by clinicians, compliance with protocol instructions,
hospital discharge disposition, hospital, 30-day, and 90-day mortality, time to first ICU
activity, hospital length of stay, ICU length of stay, heath care utilization, quality of
life, and costs of care. As the iCentra electronic medical record is implemented at
Intermountain Healthcare hospitals, clinicians will have the opportunity to use the
computerized lung protective ventilation protocol, or to order mechanical ventilation
settings independently. This is an observational study designed to measure how often the
computerized lung protective ventilation protocol will be ordered, compliance with the
instructions of the protocol, and clinical outcomes among patients who are managed with the
protocol. Physicians may choose to use the protocol on intubated patients requiring
mechanical ventilation or they may choose to order other specific mechanical ventilator
settings.
This is an observational quality improvement study comparing outcomes before, and after,
implementation of a proven lung protective ventilation protocol in an electronic medical
record system, iCentra, that will be implemented in phases across Intermountain Healthcare
hospitals. A phased implementation with a two-month washout period will be used to evaluate
the primary outcome of interest, ventilator free days (VFDs) to 28 days. Secondary outcomes
will include: use of the protocol by clinicians, compliance with protocol instructions,
hospital discharge disposition, hospital, 30-day, and 90-day mortality, time to first ICU
activity, hospital length of stay, ICU length of stay, heath care utilization, quality of
life, and costs of care. As the iCentra electronic medical record is implemented at
Intermountain Healthcare hospitals, clinicians will have the opportunity to use the
computerized lung protective ventilation protocol, or to order mechanical ventilation
settings independently. This is an observational study designed to measure how often the
computerized lung protective ventilation protocol will be ordered, compliance with the
instructions of the protocol, and clinical outcomes among patients who are managed with the
protocol. Physicians may choose to use the protocol on intubated patients requiring
mechanical ventilation or they may choose to order other specific mechanical ventilator
settings.
Inclusion Criteria
1. Initiation of mechanical ventilation in the emergency department or intensive care
unit at an Intermountain Healthcare hospital
2. Age ≥ 18 years
Exclusion Criteria
1. Transition to comfort care in the emergency department or on the same day of admission
to the ICU
2. Death on the same day of admission to the emergency department or ICU
We found this trial at
1
site
Click here to add this to my saved trials
