Computerized decision support for mechanical ventilation of trauma induced ARDS: Results of a randomized clinical trial

Bruce A. McKinley, Frederick A. Moore, R. Matthew Sailors, Christine S Cocanour, Alicia Marquez, Roberta K. Wright, Alan S. Tonnesen, C. Jane Wallace, Alan H. Morris, Thomas D. East

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: Variability and logistic complexity of mechanical ventilatory support of acute respiratory distress syndrome, and need to standardize care among all clinicians and patients, led University of Utah/LDS Hospital physicians, nurses, and engineers to develop a comprehensive computerized protocol. This bedside decision support system was the basis of a multicenter clinical trial (1993-1998) that showed ability to export a computerized protocol to other sites and improved efficacy with computer- versus physician-directed ventilatory support. The Memorial Hermann Hospital Shock Trauma intensive care unit (ICU) (Houston, TX; a Level I trauma center and teaching affiliate of The University of Texas Houston Medical School) served as one of the 10 trial sites and recruited two thirds of the trauma patients. Results from the trauma patient subgroup at this site are reported to answer three questions: Can a computerized protocol be successfully exported to a trauma ICU? Was ventilator management different between study groups? Was patient outcome affected? Methods: Sixty-seven trauma patients were randomized at the Memorial Hermann Shock Trauma ICU site. "Protocol" assigned patients had ventilatory support directed by the bedside respiratory therapist using the computerized protocol. "Nonprotocol" patients were managed by physician orders. Results: Of the 67 trauma patients randomized, 33 were protocol (age 40 ± 3; Injury Severity Score [ISS] 26 ± 3; 73% blunt) and 34 were nonprotocol (age 38 ± 2; ISS 25 ± 2; 76% blunt). For the protocol group, the computerized protocol was used 96% of the time of ventilatory support and 95% of computer-generated instructions were followed by the bedside respiratory therapist. Outcome measures (i.e., survival, ICU length of stay, morbidity, and barotrauma) were not significantly different between groups. FIO 2 ≥ 0.6 and Pplateau ≥ 35 cm H 2O exposures were less for the protocol group. Conclusion: A computerized protocol for bedside decision support was successfully exported to a trauma center, and effectively standardized mechanical ventilatory support of trauma-induced acute respiratory distress syndrome without adverse effect on patient outcome.

Original languageEnglish (US)
Pages (from-to)415-425
Number of pages11
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume50
Issue number3
StatePublished - 2001
Externally publishedYes

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Artificial Respiration
Randomized Controlled Trials
Wounds and Injuries
Intensive Care Units
Injury Severity Score
Trauma Centers
Adult Respiratory Distress Syndrome
Physicians
Shock
Barotrauma
Mechanical Ventilators
Medical Schools
Multicenter Studies
Length of Stay
Teaching
Nurses
Outcome Assessment (Health Care)
Clinical Trials
Morbidity
Survival

ASJC Scopus subject areas

  • Surgery

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Computerized decision support for mechanical ventilation of trauma induced ARDS : Results of a randomized clinical trial. / McKinley, Bruce A.; Moore, Frederick A.; Sailors, R. Matthew; Cocanour, Christine S; Marquez, Alicia; Wright, Roberta K.; Tonnesen, Alan S.; Wallace, C. Jane; Morris, Alan H.; East, Thomas D.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 50, No. 3, 2001, p. 415-425.

Research output: Contribution to journalArticle

McKinley, BA, Moore, FA, Sailors, RM, Cocanour, CS, Marquez, A, Wright, RK, Tonnesen, AS, Wallace, CJ, Morris, AH & East, TD 2001, 'Computerized decision support for mechanical ventilation of trauma induced ARDS: Results of a randomized clinical trial', Journal of Trauma - Injury, Infection and Critical Care, vol. 50, no. 3, pp. 415-425.
McKinley, Bruce A. ; Moore, Frederick A. ; Sailors, R. Matthew ; Cocanour, Christine S ; Marquez, Alicia ; Wright, Roberta K. ; Tonnesen, Alan S. ; Wallace, C. Jane ; Morris, Alan H. ; East, Thomas D. / Computerized decision support for mechanical ventilation of trauma induced ARDS : Results of a randomized clinical trial. In: Journal of Trauma - Injury, Infection and Critical Care. 2001 ; Vol. 50, No. 3. pp. 415-425.
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abstract = "Background: Variability and logistic complexity of mechanical ventilatory support of acute respiratory distress syndrome, and need to standardize care among all clinicians and patients, led University of Utah/LDS Hospital physicians, nurses, and engineers to develop a comprehensive computerized protocol. This bedside decision support system was the basis of a multicenter clinical trial (1993-1998) that showed ability to export a computerized protocol to other sites and improved efficacy with computer- versus physician-directed ventilatory support. The Memorial Hermann Hospital Shock Trauma intensive care unit (ICU) (Houston, TX; a Level I trauma center and teaching affiliate of The University of Texas Houston Medical School) served as one of the 10 trial sites and recruited two thirds of the trauma patients. Results from the trauma patient subgroup at this site are reported to answer three questions: Can a computerized protocol be successfully exported to a trauma ICU? Was ventilator management different between study groups? Was patient outcome affected? Methods: Sixty-seven trauma patients were randomized at the Memorial Hermann Shock Trauma ICU site. {"}Protocol{"} assigned patients had ventilatory support directed by the bedside respiratory therapist using the computerized protocol. {"}Nonprotocol{"} patients were managed by physician orders. Results: Of the 67 trauma patients randomized, 33 were protocol (age 40 ± 3; Injury Severity Score [ISS] 26 ± 3; 73{\%} blunt) and 34 were nonprotocol (age 38 ± 2; ISS 25 ± 2; 76{\%} blunt). For the protocol group, the computerized protocol was used 96{\%} of the time of ventilatory support and 95{\%} of computer-generated instructions were followed by the bedside respiratory therapist. Outcome measures (i.e., survival, ICU length of stay, morbidity, and barotrauma) were not significantly different between groups. FIO 2 ≥ 0.6 and Pplateau ≥ 35 cm H 2O exposures were less for the protocol group. Conclusion: A computerized protocol for bedside decision support was successfully exported to a trauma center, and effectively standardized mechanical ventilatory support of trauma-induced acute respiratory distress syndrome without adverse effect on patient outcome.",
author = "McKinley, {Bruce A.} and Moore, {Frederick A.} and Sailors, {R. Matthew} and Cocanour, {Christine S} and Alicia Marquez and Wright, {Roberta K.} and Tonnesen, {Alan S.} and Wallace, {C. Jane} and Morris, {Alan H.} and East, {Thomas D.}",
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T1 - Computerized decision support for mechanical ventilation of trauma induced ARDS

T2 - Results of a randomized clinical trial

AU - McKinley, Bruce A.

AU - Moore, Frederick A.

AU - Sailors, R. Matthew

AU - Cocanour, Christine S

AU - Marquez, Alicia

AU - Wright, Roberta K.

AU - Tonnesen, Alan S.

AU - Wallace, C. Jane

AU - Morris, Alan H.

AU - East, Thomas D.

PY - 2001

Y1 - 2001

N2 - Background: Variability and logistic complexity of mechanical ventilatory support of acute respiratory distress syndrome, and need to standardize care among all clinicians and patients, led University of Utah/LDS Hospital physicians, nurses, and engineers to develop a comprehensive computerized protocol. This bedside decision support system was the basis of a multicenter clinical trial (1993-1998) that showed ability to export a computerized protocol to other sites and improved efficacy with computer- versus physician-directed ventilatory support. The Memorial Hermann Hospital Shock Trauma intensive care unit (ICU) (Houston, TX; a Level I trauma center and teaching affiliate of The University of Texas Houston Medical School) served as one of the 10 trial sites and recruited two thirds of the trauma patients. Results from the trauma patient subgroup at this site are reported to answer three questions: Can a computerized protocol be successfully exported to a trauma ICU? Was ventilator management different between study groups? Was patient outcome affected? Methods: Sixty-seven trauma patients were randomized at the Memorial Hermann Shock Trauma ICU site. "Protocol" assigned patients had ventilatory support directed by the bedside respiratory therapist using the computerized protocol. "Nonprotocol" patients were managed by physician orders. Results: Of the 67 trauma patients randomized, 33 were protocol (age 40 ± 3; Injury Severity Score [ISS] 26 ± 3; 73% blunt) and 34 were nonprotocol (age 38 ± 2; ISS 25 ± 2; 76% blunt). For the protocol group, the computerized protocol was used 96% of the time of ventilatory support and 95% of computer-generated instructions were followed by the bedside respiratory therapist. Outcome measures (i.e., survival, ICU length of stay, morbidity, and barotrauma) were not significantly different between groups. FIO 2 ≥ 0.6 and Pplateau ≥ 35 cm H 2O exposures were less for the protocol group. Conclusion: A computerized protocol for bedside decision support was successfully exported to a trauma center, and effectively standardized mechanical ventilatory support of trauma-induced acute respiratory distress syndrome without adverse effect on patient outcome.

AB - Background: Variability and logistic complexity of mechanical ventilatory support of acute respiratory distress syndrome, and need to standardize care among all clinicians and patients, led University of Utah/LDS Hospital physicians, nurses, and engineers to develop a comprehensive computerized protocol. This bedside decision support system was the basis of a multicenter clinical trial (1993-1998) that showed ability to export a computerized protocol to other sites and improved efficacy with computer- versus physician-directed ventilatory support. The Memorial Hermann Hospital Shock Trauma intensive care unit (ICU) (Houston, TX; a Level I trauma center and teaching affiliate of The University of Texas Houston Medical School) served as one of the 10 trial sites and recruited two thirds of the trauma patients. Results from the trauma patient subgroup at this site are reported to answer three questions: Can a computerized protocol be successfully exported to a trauma ICU? Was ventilator management different between study groups? Was patient outcome affected? Methods: Sixty-seven trauma patients were randomized at the Memorial Hermann Shock Trauma ICU site. "Protocol" assigned patients had ventilatory support directed by the bedside respiratory therapist using the computerized protocol. "Nonprotocol" patients were managed by physician orders. Results: Of the 67 trauma patients randomized, 33 were protocol (age 40 ± 3; Injury Severity Score [ISS] 26 ± 3; 73% blunt) and 34 were nonprotocol (age 38 ± 2; ISS 25 ± 2; 76% blunt). For the protocol group, the computerized protocol was used 96% of the time of ventilatory support and 95% of computer-generated instructions were followed by the bedside respiratory therapist. Outcome measures (i.e., survival, ICU length of stay, morbidity, and barotrauma) were not significantly different between groups. FIO 2 ≥ 0.6 and Pplateau ≥ 35 cm H 2O exposures were less for the protocol group. Conclusion: A computerized protocol for bedside decision support was successfully exported to a trauma center, and effectively standardized mechanical ventilatory support of trauma-induced acute respiratory distress syndrome without adverse effect on patient outcome.

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