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 i n 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.

Public Health Relevance

Severe acute respiratory failure with prolonged mechanical ventilation is a common and morbid condition with high mortality. By intervening in high risk patients early in their hospital course, before organ damage is established, by alerting providers to their patient's risk and prompting them towards greater adherence to proven therapies, this project aims to change the paradigm of how acute respiratory failure is managed and improve short and long term survival in a large proportion of patients admitted to the hospital.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Exploratory/Developmental Cooperative Agreement Phase II (UH3)
Project #
6UH3HL125119-07
Application #
9860101
Study Section
Special Emphasis Panel (ZHL1)
Program Officer
Reineck, Lora A
Project Start
2014-09-19
Project End
2019-07-31
Budget Start
2019-01-01
Budget End
2019-07-31
Support Year
7
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Albert Einstein College of Medicine
Department
Type
DUNS #
081266487
City
Bronx
State
NY
Country
United States
Zip Code
10461
Hope, Aluko A; Adeoye, Oriade; Chuang, Elizabeth H et al. (2018) Pre-hospital frailty and hospital outcomes in adults with acute respiratory failure requiring mechanical ventilation. J Crit Care 44:212-216
O'Gara, Brian; Marcantonio, Edward R; Pascual-Leone, Alvaro et al. (2018) Prevention of Early Postoperative Decline (PEaPoD): protocol for a randomized, controlled feasibility trial. Trials 19:676
Sakusic, Amra; Sabov, Moldovan; McCambridge, Amanda J et al. (2018) Features of Adult Hyperammonemia Not Due to Liver Failure in the ICU. Crit Care Med 46:e897-e903
Dziadzko, Mikhail A; Novotny, Paul J; Sloan, Jeff et al. (2018) Multicenter derivation and validation of an early warning score for acute respiratory failure or death in the hospital. Crit Care 22:286
Chuang, Elizabeth; Lamkin, Richard; Hope, Aluko A et al. (2017) ""I Just Felt Like I Was Stuck in the Middle"": Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting. J Pain Symptom Manage 54:27-34
Soto, Graciela J; Kor, Daryl J; Park, Pauline K et al. (2017) The authors reply. Crit Care Med 45:e625-e626
Chuang, Elizabeth; Hope, Aluko A; Allyn, Katherine et al. (2017) Gaps in Provision of Primary and Specialty Palliative Care in the Acute Care Setting by Race and Ethnicity. J Pain Symptom Manage 54:645-653.e1
Hope, Aluko A; Hsieh, S J; Petti, Alex et al. (2017) Assessing the Usefulness and Validity of Frailty Markers in Critically Ill Adults. Ann Am Thorac Soc 14:952-959
Hua, May; Gong, Michelle Ng; Miltiades, Andrea et al. (2017) Outcomes after Rehospitalization at the Same Hospital or a Different Hospital Following Critical Illness. Am J Respir Crit Care Med 195:1486-1493
Harrison, Andrew M; Gajic, Ognjen; Pickering, Brian W et al. (2016) Development and Implementation of Sepsis Alert Systems. Clin Chest Med 37:219-29

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