Computer decision support tools (computer protocols) support replicable, evidence-based decisions for equivalent patient states. Research on computer protocols in the intensive care unit (ICU) has primarily been focused on adult ICUs. The overall goal of the proposed research is to investigate the changes related to appropriate size and scale (granularity) that are required to modify a ventilator management protocol, developed for adult critical care ("adult protocol"), for pediatric practice. The adult protocol was chosen as the basis for our pediatric computer protocol because adherence to the protocol was high and it had a large impact on mechanical ventilation practices;however the applicability of the adult findings to pediatrics has yet to be established. The study is guided by the Unified Theory of Acceptance and Use of Technology (33), with focus on the computer protocol content (patient data, protocol rules, and recommendations). Specifically, we plan to use prospective observational data from patients with ALI or ARDS to evaluate ventilator management decisions in the pediatric critical care environment, when decisions are not guided by a computer protocol (social norms);and to use a web-based questionnaire with clinical scenarios to evaluate the potential level at which pediatric critical care providers would accept ventilator management decisions recommended by a computer protocol (performance expectancy). The study has a multiple PI leadership plan that capitalizes on the complementary skills of the PIs;and takes advantage of existing Collaborative Pediatric Critical Care Research Network (CPCCRN) infrastructure. CPCCRN investigators are experienced pediatric intensivists and researchers and support this study. Their commitment, large clinical sites and the stable infrastructure of the Network including the CPCCRN Data Coordinating Center, provide a strong environment for this particular study. This proposed study addresses the clinical care of children on ventilators and the variability in physician practice across PICUs with the aim of standardizing these practices. Incorporation of CDS within research is an innovative methodology that can support meaningful interventional research studies in critically ill children, which could improve outcomes. Our ultimate goal will be to undertake a study in pediatric ALI/ARDS of different modes of lung protective ventilation commonly used in pediatrics, using the computer protocol to standardize ventilator management decisions across practitioners and sites. Preliminary data from a single institution support the study hypotheses but need to be validated across multiple institutions to determine the feasibility of using a CDS tool to support research projects in the CPCCRN. Such a tested, accepted protocol should also have a beneficial effect on variability and improve care for all children requiring mechanical ventilation.

Public Health Relevance

The proposed project examines how pediatric intensive care physicians make decisions about ventilator management for patients with acute hypoxemic respiratory failure (conditions such as acute lung injury or acute respiratory distress syndrome). The study suggests use of decision support tools as an innovative methodology to support replicable, evidence-based clinician decisions regarding ventilator management in the pediatric ICU. The ultimate aim of such tools is to support research and clinical practices that would, in turn, improve the quality of PICU medical care.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-NRCS-B (01))
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Maholmes, Valerie
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Children's Hospital of Los Angeles
Los Angeles
United States
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